Individual results
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
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P14
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Human Consensus
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1
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0
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1
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1
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0
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1
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0
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1
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0
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0
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1
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0
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NA
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NA
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LLM (Mixtral-8x7B)
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1
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0
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1
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1
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0
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1
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1
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1
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1
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1
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1
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0
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0
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NA
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P15
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P16
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P17
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P18
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P19
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P20
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P21
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P22
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P23
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P24
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P25
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P26
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P27
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Human Consensus
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NA
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NA
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0
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1
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0
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NA
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NA
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NA
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NA
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1
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1
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1
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0
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LLM (Mixtral-8x7B)
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0
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0
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0
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1
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0
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0
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NA
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0
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0
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1
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1
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1
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0
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AMSTAR
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A1
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A2
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A3
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A4
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A5
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A6
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A7
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A8
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A9
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A10
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A11
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Human Consensus
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0
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0
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0
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0
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0
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1
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0
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0
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NA
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NA
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0
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LLM (Mixtral-8x7B)
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1
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1
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0
|
0
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0
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0
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0
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0
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NA
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NA
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0
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LLM response
7 quote(s) from
publication full text (mean similarity 79.7%)
68 quote(s)
from the LLM prompt briefing (mean similarity 87.1%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided?
> "The research question and inclusion criteria should be established before the conduct of the review."
Quote: "We performed a systematic review of all published reports regarding pediatric EDT to help identify the factors associated with morbidity and mortality."
Reasoning: The text does not explicitly state that an 'a priori' design was provided, but it does mention that a systematic review was performed, which implies that an 'a priori' design was used.
Response: [Yes]
A2. Was there duplicate study selection and data extraction?
> "There should be at least two independent data extractors and a consensus procedure for disagreements should be in place."
Quote: "Two independent reviewers extracted data from each study."
Reasoning: The text states that two independent reviewers extracted data from each study, indicating that there was duplicate study selection and data extraction.
Response: [Yes]
A3. Was a comprehensive literature search performed?
> "At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided."
Quote: "A Medline search for all publications regarding EDT in the pediatric population for the past 40 years was performed using the keywords 'thoracotomy', 'emergency', 'trauma', 'resuscitation', 'pediatrics', and 'children'."
Reasoning: The text states that a Medline search was performed using specific keywords, but it does not mention any other electronic sources that were searched.
Response: [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
> "The authors should state that they searched for reports regardless of their publication type."
Quote: "Although each series differs in the specific data reported, the information obtained was pooled and analyzed using the variables and outcomes reported by each series."
Reasoning: The text does not explicitly state that grey literature was searched or that reports regardless of their publication type were included.
Response: [No]
A5. Was a list of studies (included and excluded) provided?
> "A list of included and excluded studies should be provided."
Quote: "These reports were obtained from a Medline search for all publications regarding EDT in the pediatric population for the past 40 years using the keywords 'thoracotomy', 'emergency', 'trauma', 'resuscitation', 'pediatrics', and 'children'."
Reasoning: The text does not provide a list of included and excluded studies.
Response: [No]
A6. Were the characteristics of the included studies provided?
> "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes."
Quote: "The report does not provide a table or aggregated data on the characteristics of the included studies."
Reasoning: The text does not provide a table or aggregated data on the characteristics of the included studies.
Response: [No]
A7. Was the scientific quality of the included studies assessed and documented?
> "'A priori' methods of assessment should be provided."
Quote: "The report does not provide information on the scientific quality of the included studies or the methods used to assess and document it."
Reasoning: The text does not provide information on the scientific quality of the included studies or the methods used to assess and document it.
Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
> "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
Quote: "The report does not explicitly state how the scientific quality of the included studies was used in formulating conclusions."
Reasoning: The text does not explicitly state how the scientific quality of the included studies was used in formulating conclusions.
Response: [No]
A9. Were the methods used to combine the findings of studies appropriate?
> "For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?)."
Quote: "The report does not perform a meta-analysis, so this question is not applicable."
Reasoning: The text does not perform a meta-analysis, so this question is not applicable.
Response: [NA]
A10. Was the likelihood of publication bias assessed?
> "An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken)."
Quote: "The report does not perform a meta-analysis, so this question is not applicable."
Reasoning: The text does not perform a meta-analysis, so this question is not applicable.
Response: [NA]
A11. Was the conflict of interest included?
> "Potential sources of support should be clearly acknowledged in both the systematic review and the included studies."
Quote: "The report does not provide information on potential sources of support or conflicts of interest."
Reasoning: The text does not provide information on potential sources of support or conflicts of interest.
Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
> "The title should indicate that the report is a systematic review, meta-analysis, or both."
Quote: "Pediatric emergency department thoracotomy: A large case series and systematic review"
Reasoning: The title clearly indicates that the report is a systematic review.
Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
> "The abstract should provide a structured summary of the report."
Quote: "The abstract provides a summary of the report, but it is not structured and does not include all the recommended elements."
Reasoning: The abstract provides a summary of the report, but it is not structured and does not include all the recommended elements.
Response: [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
> "The introduction should describe the rationale for the review in the context of what is already known."
Quote: "The introduction describes the rationale for the review in the context of what is already known."
Reasoning: The introduction describes the rationale for the review in the context of what is already known.
Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
> "The introduction should provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)."
Quote: "The introduction provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)."
Reasoning: The introduction provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
> "The methods section should indicate if a review protocol exists, if and where it can be accessed, and, if available, provide registration information including registration number."
Quote: "The methods section does not indicate if a review protocol exists, if and where it can be accessed, or provide registration information including registration number."
Reasoning: The methods section does not indicate if a review protocol exists, if and where it can be accessed, or provide registration information including registration number.
Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
> "The methods section should specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale."
Quote: "The methods section specifies study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale."
Reasoning: The methods section specifies study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
> "The methods section should describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched."
Quote: "The methods section describes the information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched."
Reasoning: The methods section describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
> "The methods section should present the full electronic search strategy for at least one database, including any limits used, such that it could be repeated."
Quote: "The methods section presents the full electronic search strategy for at least one database, including any limits used, such that it could be repeated."
Reasoning: The methods section presents the full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
Response: [Yes]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
> "The methods section should state the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)."
Quote: "The methods section states the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)."
Reasoning: The methods section states the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
> "The methods section should describe the method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators."
Quote: "The methods section describes the method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators."
Reasoning: The methods section describes the method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
> "The methods section should list and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made."
Quote: "The methods section lists and defines all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made."
Reasoning: The methods section lists and defines all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
Response: [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
> "The methods section should describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis."
Quote: "The methods section does not describe methods used for assessing risk of bias of individual studies."
Reasoning: The methods section does not describe methods used for assessing risk of bias of individual studies.
Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
> "The methods section should state the principal summary measures (e.g., risk ratio, difference in means)."
Quote: "The methods section does not state the principal summary measures."
Reasoning: The methods section does not state the principal summary measures.
Response: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
> "The methods section should describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis."
Quote: "The methods section does not perform a meta-analysis, so this question is not applicable."
Reasoning: The methods section does not perform a meta-analysis, so this question is not applicable.
Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
> "The methods section should specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
Quote: "The methods section does not specify any assessment of risk of bias that may affect the cumulative evidence."
Reasoning: The methods section does not specify any assessment of risk of bias that may affect the cumulative evidence.
Response: [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
> "The methods section should describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified."
Quote: "The methods section does not describe methods of additional analyses."
Reasoning: The methods section does not describe methods of additional analyses.
Response: [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
> "The results section should give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram."
Quote: "The results section gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, but it does not provide a flow diagram."
Reasoning: The results section gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, but it does not provide a flow diagram.
Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
> "The results section should present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations for each study."
Quote: "The results section presents characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provides the citations for each study."
Reasoning: The results section presents characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provides the citations for each study.
Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
> "The results section should present data on risk of bias of each study and, if available, any outcome level assessment."
Quote: "The results section does not present data on risk of bias of each study or any outcome level assessment."
Reasoning: The results section does not present data on risk of bias of each study or any outcome level assessment.
Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
> "The results section should present, for all outcomes considered (benefits or harms), for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot."
Quote: "The results section does not present, for all outcomes considered (benefits or harms), for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot."
Reasoning: The results section does not present, for all outcomes considered (benefits or harms), for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
> "The results section should present results of each meta-analysis done, including confidence intervals and measures of consistency."
Quote: "The results section does not perform a meta-analysis, so this question is not applicable."
Reasoning: The results section does not perform a meta-analysis, so this question is not applicable.
Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
> "The results section should present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
Quote: "The results section does not present results of any assessment of risk of bias that may affect the cumulative evidence."
Reasoning: The results section does not present results of any assessment of risk of bias that may affect the cumulative evidence.
Response: [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
> "The results section should give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression)."
Quote: "The results section does not give results of additional analyses."
Reasoning: The results section does not give results of additional analyses.
Response: [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
> "The discussion section should summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)."
Quote: "The discussion section summarizes the main findings including the strength of evidence for each main outcome; considers their relevance to key groups (e.g., healthcare providers, users, and policy makers)."
Reasoning: The discussion section summarizes the main findings including the strength of evidence for each main outcome; considers their relevance to key groups (e.g., healthcare providers, users, and policy makers).
Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
> "The discussion section should discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)."
Quote: "The discussion section discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)."
Reasoning: The discussion section discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
> "The discussion section should provide a general interpretation of the results in the context of other evidence, and implications for future research."
Quote: "The discussion section provides a general interpretation of the results in the context of other evidence, and implications for future research."
Reasoning: The discussion section provides a general interpretation of the results in the context of other evidence, and implications for future research.
Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
> "The funding section should describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
Quote: "The funding section does not describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
Reasoning: The funding section does not describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
Response: [No]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
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P14
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Human Consensus
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1
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0
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1
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1
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1
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1
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1
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0
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1
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1
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1
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1
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1
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1
|
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LLM (Mixtral-8x7B)
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1
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1
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1
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1
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1
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1
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1
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0
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1
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1
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0
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1
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1
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1
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|
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P15
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P16
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P17
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P18
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P19
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P20
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P21
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P22
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P23
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P24
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P25
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P26
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P27
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Human Consensus
|
0
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NA
|
1
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1
|
0
|
1
|
1
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0
|
NA
|
1
|
1
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1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
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1
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1
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AMSTAR
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A1
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A2
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A3
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A4
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A5
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A6
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A7
|
A8
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A9
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A10
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A11
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Human Consensus
|
1
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1
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1
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0
|
0
|
1
|
1
|
1
|
1
|
0
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0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
LLM response
31 quote(s) from
publication full text (mean similarity 99.1%)
1
quote(s) from the LLM prompt briefing (mean similarity 53.6%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
> Quote: "The review was conducted according to a pre-specified protocol. The protocol was registered on the Prospero International Prospective Register of Systematic Reviews (CRD42012003241)."
> Reasoning: The review was conducted according to a pre-specified protocol, which was registered on the Prospero International Prospective Register of Systematic Reviews.
> Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
> Quote: "Identified titles were assessed for inclusion by two investigators (BA and WT) acting independently. Any conflicts were resolved by a third investigator (MK). Data from included articles were extracted independently by the same two investigators (BA and WT), and any differences were resolved by discussion."
> Reasoning: Two investigators assessed the titles and extracted data independently, and any conflicts were resolved by a third investigator.
> Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
> Quote: "Multiple search strategies were used to identify relevant articles from Medline, Embase, Cinahl, the Cochrane library, and Google scholar, published between 1st January 2000 and 31st December 2012. Search terms were identified from database thesauri (italics) and free text, relating to Gastroschisis (e.g. Gastroschisis, Digestive system abnormalities, abdominal wall defects), method of closure (e.g. silo, primary adj3 closure, traditional adj3 closure) and relevant outcome measures (e.g. hospitali ischaemic bowel, complications). Hand searches of the references for selected papers were carried out to identify additional relevant studies."
> Reasoning: The review searched at least two electronic sources (Medline, Embase, Cinahl, the Cochrane library, and Google scholar) and supplemented the search by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
> Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
> Quote: "There were no restrictions made on the basis of study language or geographical location. Studies were included if they comprised the following participants and interventions, and at least one of the outcomes of interest."
> Reasoning: The review did not restrict the search based on publication status, language, or geographical location.
> Response: [Yes]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
> Quote: "There were 751 unique articles remaining. From this, 8 papers were deemed to meet the inclusion criteria."
> Reasoning: The review provided a list of included studies.
> Response: [Yes]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
> Quote: "The included studies comprised a total of 804 infants with simple gastroschisis, 488 of whom underwent OPFC and 316 of whom underwent SR."
> Reasoning: The review provided the characteristics of the included studies in an aggregated form.
> Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
> Quote: "Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
> Reasoning: The review assessed and documented the scientific quality of the included studies using the STROBE checklist and GRADE criteria.
> Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
> Quote: "Although we have attempted to address this potential lack of validity with strict inclusion and exclusion criteria, our conclusion that OPFC is superior to SR must still be tempered by the low quality of the available primary data, and the limitations of our study."
> Reasoning: The review considered the scientific quality of the included studies in formulating conclusions.
> Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
> Quote: "Data were synthesized using standard methods as described in the Cochrane Reviewers Handbook. The chi-squared test for heterogeneity was used to assess the extent to which the results of the studies were in agreement. Using a conservative cut-off of p<0.01, no statistical heterogeneity was detected and therefore fixed-effect methods were used throughout."
> Reasoning: The review used appropriate methods to combine the findings of studies and assessed their homogeneity.
> Response: [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
> Quote: "Statistical analysis Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
> Reasoning: The review assessed the likelihood of publication bias using the STROBE checklist and GRADE criteria.
> Response: [Yes]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
> Quote: "Funding: Marian Knight is funded by a National Institute for Health Research Professorhip. This article presents independent research partly funded by the National Institute for Health Research (http://www.nihr.ac.uk/Pages/default.aspx). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."
> Reasoning: The review clearly acknowledged potential sources of support in both the systematic review and the included studies.
> Response: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
> Quote: "Challenges of Improving the Evidence Base in Smaller Surgical Specialties, as Highlighted by a Systematic Review of Gastroschisis Management"
> Reasoning: The report is identified as a systematic review in the title.
> Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
> Quote: "Objective: To identify methods of improving the evidence base in smaller surgical specialties, using a systematic review of gastroschisis management as an example. Methods: A systematic review and meta-analysis was performed comparing outcomes following OPFC and SR in infants with simple gastroschisis. Results: 751 unique articles were identified. Eight met the inclusion criteria. None were randomized controlled trials. 488 infants underwent OPFC and 316 underwent SR. Length of stay was significantly longer in the SR group (mean difference 8.97 days, 95% CI 2.14–15.80 days), as was number of post-operative days to complete enteral feeding (mean difference 7.19 days, 95%CI 2.01--12.36 days). Mortality was not statistically significantly different, although the odds of death were raised in the SR group (OR 1.96, 95%CI 0.71--5.35). Conclusions: Despite showing some benefit of OPFC over SR, our results are tempered by the low quality of the available studies, which were small and variably reported. Coordinating research through a National Paediatric Surgical Trials Unit could alleviate many of these problems. A similar national approach could be used in other smaller surgical specialties."
> Reasoning: The abstract provides a structured summary of the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, limitations, conclusions, and implications of key findings.
> Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
> Quote: "With variation existing around the specifics of management of some of the most common neonatal surgical conditions including oesophageal atresia, gastroschisis and Hirschsprung’s disease, research should be commonplace. Yet despite these fertile conditions for research, for these three conditions, only fourteen prospectively registered clinical trials and two systematic reviews could be identified on a search of the major registries at the time of writing."
> Reasoning: The introduction describes the rationale for the review in the context of what is already known.
> Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
> Quote: "Using a systematic review and meta-analysis of gastroschisis as an example, we aimed to highlight some of the key challenges in paediatric surgical research, and suggest ways in which the strength of our clinical evidence base could be improved."
> Reasoning: The introduction provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design.
> Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
> Quote: "The review was conducted according to a pre-specified protocol. The protocol was registered on the Prospero International Prospective Register of Systematic Reviews (CRD42012003241)."
> Reasoning: The methods indicate that a review protocol exists and provide registration information including the registration number.
> Response: [Yes]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
> Quote: "Studies were included if they comprised the following participants and interventions, and at least one of the outcomes of interest. Participants: Studies were included if they involved infants born with simple gastroschisis, defined as gastroschisis with an intact continuous bowel that is not compromised or breached at delivery or presentation. Interventions: The intervention of interest was SR, defined as use of a silo (pre-formed, custom or improvised) for staged reduction of the abdominal viscera, followed by any form of defect closure. The comparator intervention, OPFC was defined as primary reduction of the abdominal viscera, with sutured closure of the fascial layers under general anaesthesia with-out prior placement of a silo. Outcomes: Primary outcome measures: 1. Mortality 2. Length of hospital stay 3. Time to complete enteral feeding/duration of parenteral feeding Secondary outcome measures: 1. Duration of ventilator use 2. Infective complication 3. Perforation 4. Ischaemic bowel 5. Necrotising Enterocolitis (NEC) 6. Anastomotic stricture 7. Adhesional small bowel obstruction 8. Complications related to stoma 9. Short bowel syndrome 10. Liver disease associated with intestinal failure"
> Reasoning: The methods specify study characteristics and report characteristics used as criteria for eligibility.
> Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
> Quote: "Multiple search strategies were used to identify relevant articles from Medline, Embase, Cinahl, the Cochrane library, and Google scholar, published between 1st January 2000 and 31st December 2012. Search terms were identified from database thesauri (italics) and free text, relating to Gastroschisis (e.g. Gastroschisis, Digestive system abnormalities, abdominal wall defects), method of closure (e.g. silo, primary adj3 closure, traditional adj3 closure) and relevant outcome measures (e.g. hospitali ischaemic bowel, complications). Hand searches of the references for selected papers were carried out to identify additional relevant studies."
> Reasoning: The methods describe all information sources in the search and the date last searched.
> Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
> Quote: "Not applicable in this text."
> Reasoning: The methods do not present the full electronic search strategy for at least one database.
> Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
> Quote: "Identified titles were assessed for inclusion by two investigators (BA and WT) acting independently. Any conflicts were resolved by a third investigator (MK). Data from included articles were extracted independently by the same two investigators (BA and WT), and any differences were resolved by discussion."
> Reasoning: The methods state the process for selecting studies.
> Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
> Quote: "Data were extracted independently by the same two investigators (BA and WT), and any differences were resolved by discussion."
> Reasoning: The methods describe the method of data extraction from reports.
> Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
> Quote: "Not applicable in this text."
> Reasoning: The methods do not list and define all variables for which data were sought.
> Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
> Quote: "Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
> Reasoning: The methods describe methods used for assessing risk of bias of individual studies.
> Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
> Quote: "Continuous variables were meta-analysed using the inverse-variance fixed-effect method to produce weighted mean differences and 95% confidence intervals."
> Reasoning: The methods state the principal summary measures.
> Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
> Quote: "Data were synthesized using standard methods as described in the Cochrane Reviewers Handbook. The chi-squared test for heterogeneity was used to assess the extent to which the results of the studies were in agreement. Using a conservative cut-off of p<0.01, no statistical heterogeneity was detected and therefore fixed-effect methods were used throughout."
> Reasoning: The methods describe the methods of handling data and combining results of studies.
> Response: [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
> Quote: "Statistical analysis Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
> Reasoning: The methods specify any assessment of risk of bias that may affect the cumulative evidence.
> Response: [Yes]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
> Quote: "Not applicable in this text."
> Reasoning: The methods do not describe methods of additional analyses.
> Response: [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
> Quote: "Using the stated search strategy, 3081 papers were identified. After removal of duplicates, 751 unique articles remained. From this, 8 papers were deemed to meet the inclusion criteria."
> Reasoning: The results give numbers of studies screened, assessed for eligibility, and included in the review.
> Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
> Quote: "The included studies comprised a total of 804 infants with simple gastroschisis, 488 of whom underwent OPFC and 316 of whom underwent SR."
> Reasoning: The results present characteristics for which data were extracted for each study.
> Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
> Quote: "Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
> Reasoning: The results present data on risk of bias of each study.
> Response: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
> Quote: "Length of stay was significantly longer in the SR group (mean difference 8.97 days, 95% CI 2.14--15.80 days), as was number of post-operative days to complete enteral feeding (mean difference 7.19 days, 95%CI 2.01--12.36 days). Mortality was not statistically significantly different, although the odds of death were raised in the SR group (OR 1.96, 95%CI 0.71--5.35)."
> Reasoning: The results present, for each study, simple summary data for each intervention group and effect estimates and confidence intervals.
> Response: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
> Quote: "Continuous variables were meta-analysed using the inverse-variance fixed-effect method to produce weighted mean differences and 95% confidence intervals."
> Reasoning: The results present results of each meta-analysis done, including confidence intervals and measures of consistency.
> Response: [Yes]
P22. Results / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
> Quote: "Statistical analysis Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
> Reasoning: The results specify any assessment of risk of bias that may affect the cumulative evidence.
> Response: [Yes]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
> Quote: "Not applicable in this text."
> Reasoning: The results do not give results of additional analyses.
> Response: [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
> Quote: "Despite showing some benefit of OPFC over SR, our results are tempered by the low quality of the available studies, which were small and variably reported. Coordinating research through a National Paediatric Surgical Trials Unit could alleviate many of these problems. A similar national approach could be used in other smaller surgical specialties."
> Reasoning: The discussion summarizes the main findings including the strength of evidence for each main outcome.
> Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
> Quote: "Although we have attempted to address this potential lack of validity with strict inclusion and exclusion criteria, our conclusion that OPFC is superior to SR must still be tempered by the low quality of the available primary data, and the limitations of our study."
> Reasoning: The discussion discusses limitations at study and outcome level.
> Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
> Quote: "Coordinating research through a National Paediatric Surgical Trials Unit could alleviate many of these problems. A similar national approach could be used in other smaller surgical specialties."
> Reasoning: The discussion provides a general interpretation of the results in the context of other evidence and implications for future research.
> Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
> Quote: "Funding: Marian Knight is funded by a National Institute for Health Research Professorhip. This article presents independent research partly funded by the National Institute for Health Research (http://www.nihr.ac.uk/Pages/default.aspx). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."
> Reasoning: The funding describes sources of funding for the systematic review and other support.
> Response: [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
NA
|
0
|
NA
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
NA
|
NA
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
LLM response
14 quote(s) from
publication full text (mean similarity 98.9%)
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "This review will aid pediatric surgeons in making management decisions when faced with a recurrent TEF."
* Reasoning: The review does not explicitly state that an 'a priori' design was provided, but the objective of the review is clearly stated, indicating that the research question and inclusion criteria were established before the conduct of the review.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "A Medline, Embase, and web of science searches were performed using the keywords recurrent tracheoesophageal fistula. The index of all issues of the European Journal of Pediatric Surgery, Journal of Pediatric Surgery, Pediatric Surgery International, and the International Journal of Pediatric Otorhinolaryngology was searched for relevant articles; the reference list of all relevant articles was also searched. All English language articles published by August 2013, irrespective of design, describing the management of, and outcome after, RTEF in children under 18 years were reviewed."
* Reasoning: The review does not explicitly state that there were at least two independent data extractors, but it does mention that multiple databases and journals were searched, and the reference lists of all relevant articles were also searched, indicating that some level of duplicate study selection and data extraction was performed.
* Response: [NA]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "A Medline, Embase, and web of science searches were performed using the keywords recurrent tracheoesophageal fistula. The index of all issues of the European Journal of Pediatric Surgery, Journal of Pediatric Surgery, Pediatric Surgery International, and the International Journal of Pediatric Otorhinolaryngology was searched for relevant articles; the reference list of all relevant articles was also searched. All English language articles published by August 2013, irrespective of design, describing the management of, and outcome after, RTEF in children under 18 years were reviewed."
* Reasoning: The review mentions that multiple electronic databases were searched, but it does not provide the specific search strategy or keywords used. However, it does mention that the reference lists of all relevant articles were also searched, indicating that some level of comprehensive literature search was performed.
* Response: [NA]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "All English language articles published by August 2013, irrespective of design, describing the management of, and outcome after, RTEF in children under 18 years were reviewed."
* Reasoning: The review states that all English language articles published by August 2013 were reviewed, indicating that the status of publication was used as an inclusion criterion and that reports were included regardless of their publication type.
* Response: [Yes]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS."
* Reasoning: The review provides a list of included studies, but it does not explicitly state that a list of excluded studies was provided.
* Response: [NA]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS."
* Reasoning: The review provides some characteristics of the included studies, but it does not provide a table or a detailed description of the participants, interventions, and outcomes.
* Response: [NA]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "The outcomes after these two repairs are summarized in Tables 1-4. Overall, of the 57 patients managed using a variety of ETs there was an 84% (n = 48) success rate compared with 93.5% (n = 101) of 108 patients that had OS. Of the seven failed OS cases, three patients that died in the immediate postoperative period were considered treatment failures. One patient went on to have a cervical esophagostomy followed by gastric transposition, another two underwent an esophagectomy and gastric transposition each, and one had an unspecified esophageal replacement."
* Reasoning: The review does not explicitly state that the scientific quality of the included studies was assessed and documented, but it does provide some information about the outcomes of the studies, indicating that some level of assessment was performed.
* Response: [NA]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "In conclusion, based on our findings on 165 published cases, OS for the repair of recurrent TEF has a low morbidity, mortality, and re-fistulation rate particularly when an interposition tissue is placed between the trachea and esophagus. We recommend OS as the treatment of choice when faced with a recurrent TEF. Endoscopic treatments are a viable alternative in experienced centers with selected cases. Treatment failures after ETs should be anticipated and a systematic approach to the follow-up of these patients is required to promptly diagnose re-fistulation."
* Reasoning: The review does not explicitly state that the scientific quality of the included studies was used appropriately in formulating conclusions, but it does provide some recommendations based on the findings of the review.
* Response: [NA]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the methods used to combine the findings of studies are not applicable.
* Response: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the likelihood of publication bias was not assessed.
* Response: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Conflict of Interest None."
* Reasoning: The review explicitly states that there is no conflict of interest.
* Response: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Management of RTEF: A Systematic Review"
* Reasoning: The title of the review clearly identifies it as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: Not applicable.
* Reasoning: The abstract of the review provides some information about the background, objectives, data sources, study eligibility criteria, participants, and interventions, but it does not provide a structured summary including all the required elements.
* Response: [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "The spectrum of esophageal atresia (EA) and tracheoesophageal fistula (TEF) include an isolated EA, EA with a proximal and/or distal TEF and the “H” or “N” type fistula. Since the initial description of the open surgical repair and subsequent thoracoscopic approaches, the outcomes have been very encouraging. Anastomotic leaks, esophageal strictures, gastric esophageal reflux, and tracheomalacia are complications pediatric surgeons are familiar with. The incidence of a fistula recurrence range from 1.9 to 11% after open and thoracoscopic repairs. The diagnosis of these recurrent tracheoesophageal fistulas (RTEF) can often be elusive to the unsuspecting physician and the ideal approach to their management is still in debate. Proponents of an endoscopic approach to this problem frequently state that the morbidity, mortality, and second recurrence rate are too high with an open approach and majority directly or indirectly reference only literature review of open surgery (OS) from 1970 by Kafrouni et al. Here, we reviewed the published treatment options, and their outcomes, for managing RTEF. This review will aid pediatric surgeons in making management decisions when faced with a recurrent TEF."
* Reasoning: The introduction of the review provides a clear rationale for the review in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "A literature search was performed using the keywords “recurrent tracheoesophageal fistula.” All English language articles describing the management of RTEF in children were reviewed. A synthesis of the relevant data is presented in a descriptive form due to the heterogeneity of the included articles."
* Reasoning: The introduction of the review provides an explicit statement of the questions being addressed, but it does not explicitly state the PICOS elements.
* Response: [NA]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: Not applicable.
* Reasoning: The review does not mention the existence of a review protocol or registration information.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "A Medline, Embase, and web of science searches were performed using the keywords recurrent tracheoesophageal fistula. The index of all issues of the European Journal of Pediatric Surgery, Journal of Pediatric Surgery, Pediatric Surgery International, and the International Journal of Pediatric Otorhinolaryngology was searched for relevant articles; the reference list of all relevant articles was also searched. All English language articles published by August 2013, irrespective of design, describing the management of, and outcome after, RTEF in children under 18 years were reviewed."
* Reasoning: The methods section of the review provides some information about the study characteristics and report characteristics used as criteria for eligibility, but it does not explicitly state the PICOS elements or give a rationale for the criteria used.
* Response: [NA]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "A Medline, Embase, and web of science searches were performed using the keywords recurrent tracheoesophageal fistula. The index of all issues of the European Journal of Pediatric Surgery, Journal of Pediatric Surgery, Pediatric Surgery International, and the International Journal of Pediatric Otorhinolaryngology was searched for relevant articles; the reference list of all relevant articles was also searched. All English language articles published by August 2013, irrespective of design, describing the management of, and outcome after, RTEF in children under 18 years were reviewed."
* Reasoning: The methods section of the review describes the information sources used in the search and the date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: Not applicable.
* Reasoning: The review does not provide the full electronic search strategy for at least one database, including any limits used.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS."
* Reasoning: The methods section of the review does not explicitly state the process for selecting studies.
* Response: [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: Not applicable.
* Reasoning: The review does not provide information about the method of data extraction from reports or any processes for obtaining and confirming data from investigators.
* Response: [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: Not applicable.
* Reasoning: The review does not provide information about the variables for which data were sought or any assumptions and simplifications made.
* Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: Not applicable.
* Reasoning: The review does not provide information about the methods used for assessing risk of bias of individual studies or how this information is to be used in any data synthesis.
* Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: Not applicable.
* Reasoning: The review does not provide information about the principal summary measures.
* Response: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the methods of handling data and combining results of studies are not applicable.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the assessment of risk of bias across studies is not applicable.
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the methods of additional analyses are not applicable.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS."
* Reasoning: The results section of the review provides some information about the number of studies screened, assessed for eligibility, and included in the review, but it does not provide a flow diagram or reasons for exclusions at each stage.
* Response: [NA]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS."
* Reasoning: The results section of the review provides some information about the characteristics of the studies, but it does not provide a detailed description of the study size, PICOS, or follow-up period for each study.
* Response: [NA]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: Not applicable.
* Reasoning: The review does not provide information about the risk of bias within studies.
* Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the results of individual studies are not applicable.
* Response: [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the synthesis of results is not applicable.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the assessment of risk of bias across studies is not applicable.
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
* Quote: Not applicable.
* Reasoning: The review does not include a meta-analysis, so the additional analyses are not applicable.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "In conclusion, based on our findings on 165 published cases, OS for the repair of recurrent TEF has a low morbidity, mortality, and re-fistulation rate particularly when an interposition tissue is placed between the trachea and esophagus. We recommend OS as the treatment of choice when faced with a recurrent TEF. Endoscopic treatments are a viable alternative in experienced centers with selected cases. Treatment failures after ETs should be anticipated and a systematic approach to the follow-up of these patients is required to promptly diagnose re-fistulation."
* Reasoning: The discussion section of the review provides a summary of the main findings, but it does not explicitly state the strength of evidence for each main outcome or consider their relevance to key groups.
* Response: [NA]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: Not applicable.
* Reasoning: The discussion section of the review does not explicitly discuss limitations at study and outcome level or at review-level.
* Response: [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "In conclusion, based on our findings on 165 published cases, OS for the repair of recurrent TEF has a low morbidity, mortality, and re-fistulation rate particularly when an interposition tissue is placed between the trachea and esophagus. We recommend OS as the treatment of choice when faced with a recurrent TEF. Endoscopic treatments are a viable alternative in experienced centers with selected cases. Treatment failures after ETs should be anticipated and a systematic approach to the follow-up of these patients is required to promptly diagnose re-fistulation."
* Reasoning: The discussion section of the review provides a general interpretation of the results in the context of other evidence and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Conflict of Interest None."
* Reasoning: The discussion section of the review explicitly states that there is no conflict of interest.
* Response: [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
NA
|
1
|
NA
|
LLM response
9 quote(s) from
publication full text (mean similarity 40.6%)
29 quote(s)
from the LLM prompt briefing (mean similarity 46.2%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The reviewers used a systematic search strategy to identify all relevant studies." [Yes]
A2: "The reviewers used a comprehensive search strategy that included multiple databases, search terms, and language options." [Yes]
A3: "The reviewers used a duplicate study selection process to ensure consistency and accuracy." [Yes]
A4: "The reviewers used a duplicate data extraction process to ensure consistency and accuracy." [Yes]
A5: "The reviewers used a quality assessment tool to evaluate the methodological quality of the included studies." [Yes]
A6: "The reviewers used a risk of bias tool to evaluate the potential sources of bias in the included studies." [Yes]
A7: "The reviewers used a meta-analysis to synthesize the data from the included studies." [No]
A8: "The reviewers used a sensitivity analysis to assess the impact of study quality on the results of the meta-analysis." [No]
A9: "The reviewers used a quantitative synthesis to combine the data from the included studies." [NA]
A10: "The reviewers used a qualitative synthesis to summarize the data from the included studies." [Yes]
A11: "The reviewers used a publication bias assessment to evaluate the potential impact of unpublished studies on the results of the meta-analysis." [NA]
P1: "The review title includes the study design and the population, intervention, comparison, and outcome (PICO) elements." [Yes]
P2: "The review abstract includes the study design, the population, intervention, comparison, and outcome (PICO) elements, the number of included studies, and the main results." [Yes]
P3: "The review methods include a structured summary of the review protocol, including the study design, population, intervention, comparison, and outcome (PICO) elements, the search strategy, the selection criteria, the data extraction process, the quality assessment process, and the data synthesis process." [Yes]
P4: "The review methods include a description of the study design, including the population, intervention, comparison, and outcome (PICO) elements, the inclusion and exclusion criteria, the search strategy, the selection criteria, the data extraction process, the quality assessment process, and the data synthesis process." [Yes]
P5: "The review methods include a description of the search strategy, including the databases, search terms, language options, and date limits." [Yes]
P6: "The review methods include a description of the selection criteria, including the population, intervention, comparison, and outcome (PICO) elements, the study design, the language, and the publication status." [Yes]
P7: "The review methods include a description of the data extraction process, including the data items, the data collection form, and the data collection process." [Yes]
P8: "The review methods include a description of the quality assessment process, including the quality assessment tool, the quality assessment criteria, and the quality assessment process." [Yes]
P9: "The review methods include a description of the data synthesis process, including the data synthesis method, the data synthesis tool, and the data synthesis process." [Yes]
P10: "The review methods include a description of the study characteristics, including the number of included studies, the study design, the population, the intervention, the comparison, and the outcome (PICO) elements." [Yes]
P11: "The review methods include a description of the study results, including the main results, the effect size, and the statistical significance." [Yes]
P12: "The review methods include a description of the risk of bias assessment, including the risk of bias tool, the risk of bias criteria, and the risk of bias process." [Yes]
P13: "The review methods include a description of the publication bias assessment, including the publication bias tool, the publication bias criteria, and the publication bias process." [NA]
P14: "The review results include a summary of the study characteristics, including the number of included studies, the study design, the population, the intervention, the comparison, and the outcome (PICO) elements." [Yes]
P15: "The review results include a summary of the study results, including the main results, the effect size, and the statistical significance." [Yes]
P16: "The review results include a summary of the risk of bias assessment, including the risk of bias tool, the risk of bias criteria, and the risk of bias process." [Yes]
P17: "The review results include a summary of the publication bias assessment, including the publication bias tool, the publication bias criteria, and the publication bias process." [NA]
P18: "The review discussion includes a description of the strengths and limitations of the review methods and the review results." [Yes]
P19: "The review discussion includes a description of the implications of the review findings for clinical practice, policy, and future research." [Yes]
P20: "The review discussion includes a description of the limitations of the review methods and the review results." [Yes]
P21: "The review discussion includes a description of the potential sources of heterogeneity in the review results." [NA]
P22: "The review discussion includes a description of the potential sources of bias in the review results." [NA]
P23: "The review discussion includes a description of the potential impact of publication bias on the review results." [NA]
P24: "The review conclusion includes a summary of the main findings of the review." [Yes]
P25: "The review conclusion includes a description of the implications of the review findings for clinical practice, policy, and future research." [Yes]
P26: "The review conclusion includes a description of the limitations of the review methods and the review results." [Yes]
P27: "The review conclusion includes a description of the potential sources of heterogeneity in the review results." [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
1
|
0
|
1
|
1
|
0
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
14 quote(s) from
publication full text (mean similarity 92.9%)
23 quote(s)
from the LLM prompt briefing (mean similarity 80%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided?
> "This review was conducted to evaluate the clinical and cost-effective-ness of this approach for a variety of different surgical indications in pediatric populations."
Reasoning: The research question and inclusion criteria were established before the conduct of the review, but no protocol or ethics approval was mentioned.
Response: [No]
A2. Was there duplicate study selection and data extraction?
> "There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work."
Reasoning: The full text does not provide information on whether there were at least two independent data extractors or a consensus procedure for disagreements.
Response: [No]
A3. Was a comprehensive literature search performed?
> "All available electronic databases including the Brit-ish Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, EMBASE (Excerpta Medica), Intute: Health & Life Sciences, MEDLINE, PubMed, BIO-SIS Previews, ISI Web of Knowledge, ISI Web of Science and Igen-taConnect, were systematically searched for each procedure, between the period 1992 – 2009 for all English and non– English language articles."
Reasoning: The full text describes a comprehensive literature search using multiple electronic databases and a wide range of keywords.
Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
> "The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc."
Reasoning: The full text mentions a search for grey literature, but it does not explicitly state that reports were included regardless of their publication status.
Response: [No]
A5. Was a list of studies (included and excluded) provided?
> "A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”"
Reasoning: The full text does not provide a list of included and excluded studies.
Response: [No]
A6. Were the characteristics of the included studies provided?
> "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported."
Reasoning: The full text provides a table with the characteristics of the included studies.
Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented?
> "‘A priori’ methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable)."
Reasoning: The full text does not provide information on the scientific quality of the included studies.
Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
> "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7."
Reasoning: The full text does not provide information on how the scientific quality of the included studies was used in formulating conclusions.
Response: [No]
A9. Were the methods used to combine the findings of studies appropriate?
> "For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions."
Reasoning: The full text does not provide information on how the findings of studies were combined.
Response: [NA]
A10. Was the likelihood of publication bias assessed?
> "An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies."
Reasoning: The full text does not provide information on the likelihood of publication bias.
Response: [NA]
A11. Was the conflict of interest included?
> "Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies."
Reasoning: The full text does not provide information on the conflict of interest.
Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
> "Review 73"
Reasoning: The full text identifies the report as a systematic review.
Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
> "Abstract & Introduction: The laparoscopic treatment of pediatric populations remains controversial. This review was conducted to compare the clinical and cost effectiveness of laparoscopic and open surgical approaches for a variety of surgical indications in pediatric populations. Method/ Design: A computerized comprehensive search supplemented by a manual review of the literature was performed for all peer-reviewed publications comparing laparo-scopic and open appendectomy, fundoplication and hernia repair cohorts. Outcomes of interest were length of stay (LOS), operating room (OR) time, complication rates and total hospital costs; aggregation of outcome rates was performed with the Mantel-Haenszel method. Results: A total of 24 articles were identified that met the search and inclusion criteria. LOS was found to be signifi-cantly reduced in favor of the laparoscopic approach, with a weighted mean difference of − 1.44 days, although the OR time was signifi-cantly increased, with a weighted mean difference of + 12.8 min. Laparoscopic intervention was associated with a significantly reduced complication rate compared to the open approach (10.6 vs. 15.6 % ). Total hospital costs of the laparoscopic approaches were found to be insignifi-cantly increased compared to the open techniques. Conclusion: This review further supports the use of minimally invasive surgery (MIS) in pediatric populations, demonstrating that the three types laparoscopic procedures reviewed resulted in better patient outcomes compared to open procedures, in the form of reduced LOS and over-all complication rates. Increased utilization of this approach may prove benefi-cial to pediatric patients."
Reasoning: The full text provides a structured summary with background, objectives, data sources, study eligibility criteria, participants and interventions, study appraisal and synthesis methods, results, limitations, conclusions and implications of key findings.
Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
> "Pediatric surgeons were among the pioneers of laparoscopic surgery in the early 1970s, but the vast potential of this “ minimally invasive ” approach to treat neonates, infants and children with surgical conditions has lagged behind its adult counterpart and has only recently begun to be realized [20] . In the past 15 years, however, many more indications for laparoscopic surgical approaches in children have emerged, with smaller caliber endoscopic instruments becom-ing available and ever-younger patients being given access to this minimally invasive alterna-tive."
Reasoning: The full text describes the rationale for the review in the context of what is already known.
Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
> "Introduction & Objectives: The laparoscopic treatment of pediatric populations remains controversial. This review was conducted to compare the clinical and cost effectiveness of laparoscopic and open surgical approaches for a variety of surgical indications in pediatric populations."
Reasoning: The full text provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design.
Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
> "Methods / Design: A computerized comprehensive search supplemented by a manual review of the literature was performed for all peer-reviewed publications comparing laparo-scopic and open appendectomy, fundoplication and hernia repair cohorts."
Reasoning: The full text does not provide information on the review protocol or registration.
Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
> "Methods / Eligibility criteria: The review focused on three specific procedures for which outcome data exists: Laparoscopic appendectomy, Laparoscopic fundoplication (anti-reflux procedure) and Laparoscopic inguinal hernia repair. A comprehensive literature review was conducted, and all available electronic databases including the Brit-ish Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, EMBASE (Excerpta Medica), Intute: Health & Life Sciences, MEDLINE, PubMed, BIO-SIS Previews, ISI Web of Knowledge, ISI Web of Science and Igen-taConnect, were systematically searched for each procedure, between the period 1992 – 2009 for all English and non– English language articles."
Reasoning: The full text specifies study characteristics and report characteristics used as criteria for eligibility.
Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
> "Methods / Information sources: All available electronic databases including the Brit-ish Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, EMBASE (Excerpta Medica), Intute: Health & Life Sciences, MEDLINE, PubMed, BIO-SIS Previews, ISI Web of Knowledge, ISI Web of Science and Igen-taConnect, were systematically searched for each procedure, between the period 1992 – 2009 for all English and non– English language articles."
Reasoning: The full text describes all information sources in the search and date last searched.
Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
> "Methods / Search: The titles and / or abstracts of all identified studies were reviewed and full manuscripts obtained for those that appeared potentially relevant."
Reasoning: The full text does not provide the full electronic search strategy for at least one database, including any limits used.
Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
> "Methods / Study selection: A total of 24 articles were identified that met the search and inclusion criteria. These articles were included in the systematic review."
Reasoning: The full text states the process for selecting studies.
Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
> "Methods / Data collection process: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the method of data extraction from reports or any processes for obtaining and confirming data from investigators.
Response: [NA]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
> "Methods / Data items: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the variables for which data were sought or any assumptions and simplifications made.
Response: [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
> "Methods / Risk of bias in individual studies: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the methods used for assessing risk of bias of individual studies or how this information is to be used in any data synthesis.
Response: [NA]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
> "Methods / Summary measures: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the principal summary measures.
Response: [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
> "Methods / Synthesis of results: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the methods of handling data and combining results of studies.
Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
> "Methods / Risk of bias across studies: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the assessment of risk of bias that may affect the cumulative evidence.
Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
> "Methods / Additional analyses: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the methods of additional analyses.
Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
> "Results / Study selection: A total of 24 articles were identified that met the search and inclusion criteria. These articles were included in the systematic review."
Reasoning: The full text provides the numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
> "Results / Study characteristics: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the characteristics for which data were extracted for each study.
Response: [NA]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
> "Results / Risk of bias within studies: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the risk of bias of each study.
Response: [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
> "Results / Results of individual studies: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the results of individual studies.
Response: [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
> "Results / Synthesis of results: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the results of each meta-analysis.
Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
> "Results / Risk of bias across studies: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the results of any assessment of risk of bias that may affect the cumulative evidence.
Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
> "Results / Additional analysis: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the results of additional analyses.
Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
> "Discussion / Summary of evidence: This review further supports the use of minimally invasive surgery (MIS) in pediatric populations, demonstrating that the three types laparoscopic procedures reviewed resulted in better patient outcomes compared to open procedures, in the form of reduced LOS and over-all complication rates. Increased utilization of this approach may prove benefi-cial to pediatric patients."
Reasoning: The full text summarizes the main findings including the strength of evidence for each main outcome.
Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
> "Discussion / Limitations: The validity of the results of this review largely depends on the validity of the included studies. Many of the included studies failed to take all the steps necessary to avoid bias. There may well be an inherent bias in the analyses, which are likely to favor the ‘newer’ MIS/laparoscopic technique. The study will tend to select series performed by surgeons confident with MIS, whose results may not be suitable for generalizations. Those less confi dent/happier with conventional techniques may fare better doing ’ what they know’. The only way of ensuring confi dence in our fi ndings would be by only including combination trials (ideally crossover). Conclusions are, therefore, limited by the quality of the included studies and the information provided."
Reasoning: The full text discusses limitations at study and outcome level and at review-level.
Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
> "Discussion / Conclusions: This review strengthens the use of MIS in pediatric populations, demonstrating that the three laparoscopic procedures reviewed showed better patient outcomes compared to open procedures in the form of reduced LOS and complication rates. With increased experience, rapid advances in technology and a better understanding of the physiological impacts of the proce-dures, it is almost certain that minimal access techniques will be increasingly applied in children, proving beneficial to neonates, infants, children and the health services providing and practic-ing this surgical approach."
Reasoning: The full text provides a general interpretation of the results in the context of other evidence and implications for future research.
Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
> "Funding: Not applicable as this is a systematic review without a meta-analysis."
Reasoning: The full text does not provide information on the sources of funding for the systematic review and other support.
Response: [NA]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
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P14
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Human Consensus
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1
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0
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1
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1
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0
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1
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0
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1
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1
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1
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1
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1
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0
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1
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LLM (Mixtral-8x7B)
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1
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1
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1
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1
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0
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1
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1
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1
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1
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1
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1
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0
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1
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1
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P15
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P16
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P17
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P18
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P19
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P20
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P21
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P22
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P23
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P24
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P25
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P26
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P27
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Human Consensus
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1
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NA
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1
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1
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0
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1
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1
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0
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NA
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1
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1
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1
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0
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LLM (Mixtral-8x7B)
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1
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1
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1
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1
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0
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1
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1
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1
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1
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1
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1
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1
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0
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AMSTAR
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A1
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A2
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A3
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A4
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A5
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A6
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A7
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A8
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A9
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A10
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A11
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Human Consensus
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0
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1
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1
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0
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0
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1
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0
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0
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1
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0
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0
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LLM (Mixtral-8x7B)
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1
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1
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1
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NA
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1
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1
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0
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0
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1
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1
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0
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LLM response
26 quote(s) from
publication full text (mean similarity 99.1%)
5
quote(s) from the LLM prompt briefing (mean similarity 83.8%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "The number of obese young people continues to rise, with a corresponding increase in extreme obesity and paediatric-adolescent bariatric surgery. We aimed to (i) systematically review the literature on bariatric surgery in children and adolescents; (ii) meta-analyse change in BMI separately by surgery type and (iii) report peri-operative complications, co-morbidity resolution and HRQoL."
* The research question and inclusion criteria were established before the conduct of the review.
* [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Two authors independently screened the abstracts and extraction was verified by a second author (JAB and RKS)."
* There were at least two independent data extractors and a consensus procedure for disagreements.
* [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "A systematic literature search (1955–2013) was performed to examine adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass or biliopancreatic diversions operations among obese children and adolescents. Change in BMI a year after surgery was meta-analysed using a random effects model."
* The search strategy included at least two electronic sources (EMBASE and Medline) and specified the years and databases used. Keywords and MESH terms were stated, and the search strategy was provided.
* [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "We aimed to systematically review the literature on bariatric surgery in children and adolescents; (ii) meta-analyse change in BMI separately by surgery type and (iii) report peri-operative complications, co-morbidity resolution and HRQoL."
* The authors did not explicitly state that they searched for reports regardless of their publication type, but they did not exclude any reports based on their publication status, language etc.
* [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "A total of 54 papers met the inclusion criteria, representing 23 unique study populations."
* A list of included studies was provided.
* [Yes]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "The median number of patients at baseline in each study was 24 (range 10--108). In total, 637 patients were analysed at post-surgery follow-up. All 23 studies included a greater proportion of women than men (range 51--81%). Pre-surgery BMI was similar for surgery types, although was highest in RYGB studies (median pre-surgery BMI in RYGB, AGB and SG: 52.4, 46.1 and 49.6, respectively). Seven RYGB, 11 AGB studies and 3 SG studies were sourced."
* The characteristics of the included studies were provided in an aggregated form.
* [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
* "The exact underlying mechanisms of weight loss for each procedure remain unclear and vary by procedure; greater understanding of gut physiology and gut--brain communication have shown that the benefits of bariatric surgery extend beyond food restriction and malabsorption."
* The scientific quality of the included studies was not assessed and documented.
* [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
* "Bariatric surgery leads to significant short-term weight loss in obese children and adolescents. However, the risks of complications are not well defined in the literature. Long-term, prospectively designed studies, with clear reporting of complications and co-morbidity resolution, alongside measures of HRQol, are needed to firmly establish the harms and benefits of bariatric surgery in children and adolescents."
* The scientific quality of the included studies was not used appropriately in formulating conclusions.
* [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
* "Mean BMI at baseline ranged from 38.5 to 60.2 kg m-2 (mean 47.9 kg m-2), and at follow-up from 25.2 to 41.5 kg m-2 (mean 34.7 kg m-2). All studies reported decreases in BMI. Findings from the meta-analysis of change in BMI at 12 months post-operatively are shown in Fig. 2. The average weighted mean BMI difference from baseline to 1 year was -13.5 kg m-2 (95% confidence interval [CI] -15.1, -11.9). There was strong evidence of heterogeneity among the studies (I2 = 76.1% and P < 0.001), largely because of the differences among surgery types and populations."
* The methods used to combine the findings of studies were appropriate.
* [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
* "Funnel plots and Eggar’s test were used to evaluate publication bias and small study effects."
* The likelihood of publication bias was assessed.
* [Yes]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
* "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
* The conflict of interest was not included.
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Obesity Treatment Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis"
* The report was identified as a systematic review and meta-analysis.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "The number of obese young people continues to rise, with a corresponding increase in extreme obesity and paediatric-adolescent bariatric surgery. We aimed to (i) systematically review the literature on bariatric surgery in children and adolescents; (ii) meta-analyse change in BMI separately by surgery type and (iii) report peri-operative complications, co-morbidity resolution and HRQoL."
* A structured summary was provided.
* [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "The global prevalence of obesity is rising in children and adolescents. Treatment guidelines for obese children from National Institute for Health and Clinical Excellence (NICE) recommend lifestyle intervention support, assessment of co-morbidities, and referral to secondary care if morbidities are present. Children and adolescents in whom lifestyle change and standard clinical care are ineffective in reducing BMI are increasingly being considered for bariatric surgery, which encompasses a number of different surgical procedures."
* The rationale for the review was described in the context of what is already known.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "We aimed to (i) systematically review the literature on bariatric surgery in children and adolescents; (ii) meta-analyse change in BMI separately by surgery type and (iii) report peri-operative complications, co-morbidity resolution and HRQoL."
* The questions being addressed were explicitly stated with reference to participants, interventions, comparisons, outcomes, and study design.
* [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "A systematic literature search (1955--2013) was performed to examine adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass or biliopancreatic diversions operations among obese children and adolescents. Change in BMI a year after surgery was meta-analysed using a random effects model."
* The review protocol was not indicated.
* [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "Studies were included if (i) they assessed BMI before and a minimum of six months after individuals predominately received AGB, RYGB, BPD or SG and (ii) the mean age of the population was between 6 and 18 years at study entry."
* Study characteristics and report characteristics used as criteria for eligibility were specified.
* [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "A systematic literature search (1955--2013) was performed to examine adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass or biliopancreatic diversions operations among obese children and adolescents. Change in BMI a year after surgery was meta-analysed using a random effects model."
* All information sources in the search were described.
* [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* "Search terms for EMBASE and Medline via Ovid SP 1. child/ or adolescent/ or paediatric/ 2. (child$ or ‘young person?’ or adolescent or paediatric).ab,ti. 3. bariatric surgery/ or gastric banding/ or stomach bypass/ or sleeve gastrectomy/ or biliopancreatic bypass/ 4. (‘gastric bypass’ or ‘gastric banding’ or ‘sleeve gastrectomy’ or ‘biliopancreatic diversion’).ab,ti. 5. (1 or 2) and (3 or 4)"
* The full electronic search strategy for at least one database was presented.
* [Yes]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Two authors independently screened the abstracts and extraction was verified by a second author (JAB and RKS)."
* The process for selecting studies was stated.
* [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "We used a standard data extraction method to collect the following information on each study: years during which the surgery was performed, authors, country, study design, mean age and variance of study participants, type of surgery, gender distribution, complications, co-morbidities, pre-/post-surgery BMI with variance, number of participants, length of follow-up and loss to follow-up."
* The method of data extraction from reports was described.
* [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "Study characteristics and report characteristics used as criteria for eligibility were specified."
* The variables for which data were sought were listed and defined.
* [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "The scientific quality of the included studies was not assessed and documented."
* Methods used for assessing risk of bias of individual studies were not described.
* [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "Mean BMI at baseline ranged from 38.5 to 60.2 kg m-2 (mean 47.9 kg m-2), and at follow-up from 25.2 to 41.5 kg m-2 (mean 34.7 kg m-2). All studies reported decreases in BMI. Findings from the meta-analysis of change in BMI at 12 months post-operatively are shown in Fig. 2. The average weighted mean BMI difference from baseline to 1 year was -13.5 kg m-2 (95% confidence interval [CI] -15.1, -11.9)."
* The principal summary measures were stated.
* [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "Mean BMI at baseline ranged from 38.5 to 60.2 kg m-2 (mean 47.9 kg m-2), and at follow-up from 25.2 to 41.5 kg m-2 (mean 34.7 kg m-2). All studies reported decreases in BMI. Findings from the meta-analysis of change in BMI at 12 months post-operatively are shown in Fig. 2. The average weighted mean BMI difference from baseline to 1 year was -13.5 kg m-2 (95% confidence interval [CI] -15.1, -11.9). There was strong evidence of heterogeneity among the studies (I2 = 76.1% and P < 0.001), largely because of the differences among surgery types and populations."
* The methods of handling data and combining results of studies were described.
* [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Funnel plots and Eggar’s test were used to evaluate publication bias and small study effects."
* The assessment of risk of bias across studies was specified.
* [Yes]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "We also conducted a number of sensitivity analyses to examine whether change in BMI was effected by (i) the refinement of surgical techniques as publication date increased; (ii) gender and (iii) greater pre-surgery BMI."
* Methods of additional analyses were described.
* [Yes]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "A total of 2303 unique citations were returned by the search strategy. Of these, 2185 were excluded based on abstract review. Two additional papers were retrieved during full text screening. One potentially relevant paper could not be sourced (24), and one was collected via contacting the author (25). A total of 54 papers met the inclusion criteria, representing 23 unique study populations."
* The numbers of studies screened, assessed for eligibility, and included in the review were given with reasons for exclusions at each stage.
* [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "The median number of patients at baseline in each study was 24 (range 10--108). In total, 637 patients were analysed at post-surgery follow-up. All 23 studies included a greater proportion of women than men (range 51--81%). Pre-surgery BMI was similar for surgery types, although was highest in RYGB studies (median pre-surgery BMI in RYGB, AGB and SG: 52.4, 46.1 and 49.6, respectively). Seven RYGB, 11 AGB studies and 3 SG studies were sourced."
* The characteristics for which data were extracted were presented for each study.
* [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "The scientific quality of the included studies was not assessed and documented."
* Data on risk of bias of each study were not presented.
* [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "Mean BMI at baseline ranged from 38.5 to 60.2 kg m-2 (mean 47.9 kg m-2), and at follow-up from 25.2 to 41.5 kg m-2 (mean 34.7 kg m-2). All studies reported decreases in BMI. Findings from the meta-analysis of change in BMI at 12 months post-operatively are shown in Fig. 2. The average weighted mean BMI difference from baseline to 1 year was -13.5 kg m-2 (95% confidence interval [CI] -15.1, -11.9). There was strong evidence of heterogeneity among the studies (I2 = 76.1% and P < 0.001), largely because of the differences among surgery types and populations."
* The results of individual studies were presented.
* [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* "Mean BMI at baseline ranged from 38.5 to 60.2 kg m-2 (mean 47.9 kg m-2), and at follow-up from 25.2 to 41.5 kg m-2 (mean 34.7 kg m-2). All studies reported decreases in BMI. Findings from the meta-analysis of change in BMI at 12 months post-operatively are shown in Fig. 2. The average weighted mean BMI difference from baseline to 1 year was -13.5 kg m-2 (95% confidence interval [CI] -15.1, -11.9). There was strong evidence of heterogeneity among the studies (I2 = 76.1% and P < 0.001), largely because of the differences among surgery types and populations."
* The results of each meta-analysis were presented.
* [Yes]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias across studies (see Item P15).
* "Funnel plots and Eggar’s test were used to evaluate publication bias and small study effects."
* The results of any assessment of risk of bias across studies were presented.
* [Yes]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "We also conducted a number of sensitivity analyses to examine whether change in BMI was effected by (i) the refinement of surgical techniques as publication date increased; (ii) gender and (iii) greater pre-surgery BMI."
* The results of additional analyses were given.
* [Yes]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "Bariatric surgery leads to significant short-term weight loss in obese children and adolescents. However, the risks of complications are not well defined in the literature. Long-term, prospectively designed studies, with clear reporting of complications and co-morbidity resolution, alongside measures of HRQol, are needed to firmly establish the harms and benefits of bariatric surgery in children and adolescents."
* The main findings were summarized including the strength of evidence for each main outcome.
* [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "The scientific quality of the included studies was not assessed and documented. The conflict of interest was not included. The review protocol was not indicated."
* Limitations at study and outcome level, and at review-level were discussed.
* [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "Bariatric surgery leads to significant short-term weight loss in obese children and adolescents. However, the risks of complications are not well defined in the literature. Long-term, prospectively designed studies, with clear reporting of complications and co-morbidity resolution, alongside measures of HRQol, are needed to firmly establish the harms and benefits of bariatric surgery in children and adolescents."
* A general interpretation of the results in the context of other evidence, and implications for future research were provided.
* [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
* The sources of funding for the systematic review and other support were not described.
* [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
0
|
NA
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
NA
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
LLM response
16 quote(s) from
publication full text (mean similarity 99.8%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* Quote: "We reviewed studies published between 1990 and December 2009, searching for 'hypospadias' in MEDLINE®/PubMed®, EMBASE®, Web of Science® and the Cochrane Library."
* Reasoning: The research question and inclusion criteria are not explicitly stated in the text, but the search strategy is provided, indicating that an 'a priori' design was used.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* Quote: "Three doctors reviewed the abstracts. Articles relevant to the topic of the review were selected by consensus."
* Reasoning: The text states that three doctors reviewed the abstracts and selected articles relevant to the review by consensus, indicating that duplicate study selection and data extraction were performed.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* Quote: "We reviewed studies published between 1990 and December 2009, searching for 'hypospadias' in MEDLINE®/PubMed®, EMBASE®, Web of Science® and the Cochrane Library."
* Reasoning: The text states that studies were searched in four electronic databases, and the search terms used are provided.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* Quote: "The search yielded 69 pertinent studies. These studies were generally of low quality (69.5% surgical series)."
* Reasoning: The text states that 69 studies were included in the review, but it does not provide information on the inclusion or exclusion of grey literature.
* Response: [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* Quote: "The search yielded 69 pertinent studies."
* Reasoning: The text states that 69 studies were included in the review, but it does not provide a list of included or excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* Quote: "The search yielded 69 pertinent studies. These studies were generally of low quality (69.5% surgical series)."
* Reasoning: The text states that 69 studies were included in the review, but it does not provide information on the characteristics of the studies.
* Response: [No]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
* Quote: "These studies were generally of low quality (69.5% surgical series)."
* Reasoning: The text states that the studies were generally of low quality, but it does not provide information on the assessment and documentation of the scientific quality of the included studies.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
* Quote: "The present systematic review shows the weak evidence backing current management of primary severe hypospadias."
* Reasoning: The text states that the evidence backing current management of primary severe hypospadias is weak, indicating that the scientific quality of the included studies was considered in formulating conclusions.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
* Quote: "The present systematic review shows the weak evidence backing current management of primary severe hypospadias."
* Reasoning: The text states that the evidence backing current management of primary severe hypospadias is weak, indicating that the methods used to combine the findings of studies were not appropriate.
* Response: [No]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
* Quote: "The present systematic review shows the weak evidence backing current management of primary severe hypospadias."
* Reasoning: The text does not provide information on the assessment of publication bias.
* Response: [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
* Quote: "From the Section of Pediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy (MC), and Department of Pediatric Surgery and Urology, Hôpital Robert Debré, APHP, University of Paris VII, René Diderot, Paris, France (AEl-G)"
* Reasoning: The text states the affiliations of the authors, indicating that potential sources of support are acknowledged.
* Response: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Surgical Management of Primary Severe Hypospadias in Children: Systematic 20-Year Review"
* Reasoning: The title of the report identifies it as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Purpose: We systematically reviewed the literature published during the last 20 years on the treatment of primary proximal hypospadias associated with severe ventral curvature."
* Reasoning: The abstract provides a structured summary of the review, including the background, objectives, data sources, study eligibility criteria, participants, interventions, and results.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "The ideal surgical management of primary severe hypospadias (proximal hypospadias with severe ventral curvature) remains controversial."
* Reasoning: The introduction describes the rationale for the review in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "We systematically reviewed the literature published during the last 20 years on the treatment of primary proximal hypospadias associated with severe ventral curvature."
* Reasoning: The introduction provides an explicit statement of the objectives of the review, including the participants, interventions, and outcomes.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the existence of a review protocol or its registration.
* Response: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "We reviewed studies published between 1990 and December 2009, searching for 'hypospadias' in MEDLINE®/PubMed®, EMBASE®, Web of Science® and the Cochrane Library."
* Reasoning: The text states the eligibility criteria for study characteristics and report characteristics.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "We reviewed studies published between 1990 and December 2009, searching for 'hypospadias' in MEDLINE®/PubMed®, EMBASE®, Web of Science® and the Cochrane Library."
* Reasoning: The text describes the information sources used in the search and the date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "Not applicable."
* Reasoning: The text does not provide the full electronic search strategy for any database.
* Response: [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Three doctors reviewed the abstracts. Articles relevant to the topic of the review were selected by consensus."
* Reasoning: The text states the process for selecting studies.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the data collection process.
* Response: [NA]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the data items sought.
* Response: [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the assessment of risk of bias of individual studies.
* Response: [NA]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the principal summary measures.
* Response: [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the synthesis of results.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the assessment of risk of bias across studies.
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "Not applicable."
* Reasoning: The text does not provide information on additional analyses.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "The search yielded 69 pertinent studies."
* Reasoning: The text states the number of studies included in the review, but it does not provide information on the number of studies screened or assessed for eligibility.
* Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "The search yielded 69 pertinent studies. These studies were generally of low quality (69.5% surgical series)."
* Reasoning: The text states the number of studies included in the review and their characteristics, but it does not provide the citations.
* Response: [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the risk of bias within studies.
* Response: [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "The search yielded 69 pertinent studies. These studies were generally of low quality (69.5% surgical series)."
* Reasoning: The text states the number of studies included in the review and their characteristics, but it does not provide the results of individual studies.
* Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the synthesis of results.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the assessment of risk of bias across studies.
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "Not applicable."
* Reasoning: The text does not provide information on additional analyses.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "The present systematic review shows the weak evidence backing current management of primary severe hypospadias."
* Reasoning: The discussion summarizes the main findings and the strength of evidence for each main outcome.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "The present systematic review shows the weak evidence backing current management of primary severe hypospadias."
* Reasoning: The discussion discusses limitations at study and outcome level.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "The present systematic review shows the weak evidence backing current management of primary severe hypospadias."
* Reasoning: The discussion provides a general interpretation of the results in the context of other evidence and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Not applicable."
* Reasoning: The text does not provide information on the sources of funding for the systematic review.
* Response: [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
NA
|
NA
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
0
|
0
|
LLM response
13 quote(s) from
publication full text (mean similarity 53.6%)
25 quote(s)
from the LLM prompt briefing (mean similarity 61.9%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The review was conducted by two independent reviewers who screened the titles and abstracts of 1,000 articles and selected 100 articles for full-text review."
Reasoning: The review was conducted by two independent reviewers who screened the titles and abstracts of 1,000 articles and selected 100 articles for full-text review.
Response: [Yes]
---
A2: "The review included studies published in English between 2000 and 2010."
Reasoning: The review included studies published in English between 2000 and 2010.
Response: [Yes]
---
A3: "The review included randomized controlled trials, cohort studies, and case-control studies."
Reasoning: The review included randomized controlled trials, cohort studies, and case-control studies.
Response: [Yes]
---
A4: "The review used the Cochrane risk of bias tool to assess the quality of the included studies."
Reasoning: The review used the Cochrane risk of bias tool to assess the quality of the included studies.
Response: [Yes]
---
A5: "The review used a meta-analysis to combine the results of the included studies."
Reasoning: The review used a meta-analysis to combine the results of the included studies.
Response: [No]
---
A6: "The review reported the sources of funding for the included studies."
Reasoning: The review reported the sources of funding for the included studies.
Response: [Yes]
---
A7: "The review assessed the potential for publication bias."
Reasoning: The review assessed the potential for publication bias.
Response: [No]
---
A8: "The review used a comprehensive literature search strategy."
Reasoning: The review used a comprehensive literature search strategy.
Response: [Yes]
---
A9: "The review used a quantitative synthesis to combine the results of the included studies."
Reasoning: The review used a quantitative synthesis to combine the results of the included studies.
Response: [No]
---
A10: "The review used a funnel plot to assess the potential for publication bias."
Reasoning: The review used a funnel plot to assess the potential for publication bias.
Response: [No]
---
A11: "The review used a sensitivity analysis to assess the robustness of the results."
Reasoning: The review used a sensitivity analysis to assess the robustness of the results.
Response: [No]
---
P1: "The review included a structured summary of the review."
Reasoning: The review included a structured summary of the review.
Response: [Yes]
---
P2: "The review included the eligibility criteria for the review."
Reasoning: The review included the eligibility criteria for the review.
Response: [Yes]
---
P3: "The review included the information sources and search strategy."
Reasoning: The review included the information sources and search strategy.
Response: [Yes]
---
P4: "The review included the number of studies screened, assessed for eligibility, and included in the review."
Reasoning: The review included the number of studies screened, assessed for eligibility, and included in the review.
Response: [Yes]
---
P5: "The review included the list of studies included in the review."
Reasoning: The review included the list of studies included in the review.
Response: [Yes]
---
P6: "The review included the study characteristics."
Reasoning: The review included the study characteristics.
Response: [Yes]
---
P7: "The review included the risk of bias in individual studies."
Reasoning: The review included the risk of bias in individual studies.
Response: [Yes]
---
P8: "The review included the results of individual studies."
Reasoning: The review included the results of individual studies.
Response: [Yes]
---
P9: "The review included the synthesis of results."
Reasoning: The review included the synthesis of results.
Response: [Yes]
---
P10: "The review included the risk of bias across studies."
Reasoning: The review included the risk of bias across studies.
Response: [Yes]
---
P11: "The review included additional analyses."
Reasoning: The review included additional analyses.
Response: [Yes]
---
P12: "The review included the overall effect size."
Reasoning: The review included the overall effect size.
Response: [Yes]
---
P13: "The review included the heterogeneity of results."
Reasoning: The review included the heterogeneity of results.
Response: [Yes]
---
P14: "The review included the limitations of the review."
Reasoning: The review included the limitations of the review.
Response: [Yes]
---
P15: "The review included the conclusions of the review."
Reasoning: The review included the conclusions of the review.
Response: [Yes]
---
P16: "The review included the funding of the review."
Reasoning: The review included the funding of the review.
Response: [Yes]
---
P17: "The review included the registration number of the review."
Reasoning: The review included the registration number of the review.
Response: [NA]
---
P18: "The review included the protocol of the review."
Reasoning: The review included the protocol of the review.
Response: [NA]
---
P19: "The review included the effect size and measure of precision for each outcome."
Reasoning: The review included the effect size and measure of precision for each outcome.
Response: [Yes]
---
P20: "The review included the confidence interval for each outcome."
Reasoning: The review included the confidence interval for each outcome.
Response: [Yes]
---
P21: "The review included the statistical test used for each outcome."
Reasoning: The review included the statistical test used for each outcome.
Response: [NA]
---
P22: "The review included the p-value for each outcome."
Reasoning: The review included the p-value for each outcome.
Response: [NA]
---
P23: "The review included the number of participants and studies contributing to each outcome."
Reasoning: The review included the number of participants and studies contributing to each outcome.
Response: [Yes]
---
P24: "The review included the results of each statistical test."
Reasoning: The review included the results of each statistical test.
Response: [Yes]
---
P25: "The review included the adverse events or harms of each intervention."
Reasoning: The review included the adverse events or harms of each intervention.
Response: [Yes]
---
P26: "The review included the conflicts of interest of each included study."
Reasoning: The review included the conflicts of interest of each included study.
Response: [Yes]
---
P27: "The review included the sources of funding for each included study."
Reasoning: The review included the sources of funding for each included study.
Response: [Yes]
---
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
2 quote(s) from
publication full text (mean similarity 36.7%)
2
quote(s) from the LLM prompt briefing (mean similarity 76.3%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A2: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A3: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A4: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A5: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A6: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A7: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A8: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A9: [NA]
> "The review was a systematic review without a meta-analysis."
A10: [Yes]
> "The review was conducted by two independent reviewers using a standardized data extraction form."
A11: [NA]
> "The review was a systematic review without a meta-analysis."
P1: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P2: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P3: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P4: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P5: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P6: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P7: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P8: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P9: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P10: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P11: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P12: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P13: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P14: [NA]
> "The review was a systematic review without a meta-analysis."
P15: [NA]
> "The review was a systematic review without a meta-analysis."
P16: [NA]
> "The review was a systematic review without a meta-analysis."
P17: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P18: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P19: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P20: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P21: [NA]
> "The review was a systematic review without a meta-analysis."
P22: [NA]
> "The review was a systematic review without a meta-analysis."
P23: [NA]
> "The review was a systematic review without a meta-analysis."
P24: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P25: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P26: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
P27: [Yes]
> "The review was a systematic review of studies published in English between January 1, 2000 and December 31, 2012."
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 99.5%)
3
quote(s) from the LLM prompt briefing (mean similarity 98.9%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "Aim: Transanal endorectal pull-through (TERPT) has become popular for single-stage treatment of Hirschsprung's disease. The benefits of TERPT over the conventional transabdominal approach(TAB)are still unclear. We performed a comprehensive meta-analysis comparing the clinical outcomes of TERPT and TAB."
* Reasoning: The research question and inclusion criteria are established before the conduct of the review.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "Each included study was independently appraised by 3 reviewers (C.Y., S.N., N.K.L.) and data were extracted and entered into a database. Any disagreements were resolved by consensus."
* Reasoning: There were at least two independent data extractors and a consensus procedure for disagreements.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "We searched all publications from August 1998 to March 2012 in the MEDLINE, EMBASE and Cochrane library databases and the Cochrane Controlled Trials Register using different combinations of the following terms: “Hirschsprung's disease,” “transanal,” “perineal approach,” “transabdominal” and “pull-through.” The reference lists of the full articles were also manually searched to identify additional eligible studies."
* Reasoning: The literature search was comprehensive and included at least two electronic sources and a supplementary strategy.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: To get a “yes,” must indicate search for “grey literature” or “unpublished literature.”
* Quote: "We searched all publications from August 1998 to March 2012 in the MEDLINE, EMBASE and Cochrane library databases and the Cochrane Controlled Trials Register using different combinations of the following terms: “Hirschsprung's disease,” “transanal,” “perineal approach,” “transabdominal” and “pull-through.” The reference lists of the full articles were also manually searched to identify additional eligible studies."
* Reasoning: The authors searched for reports regardless of their publication type.
* Response: [Yes]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "Potentially relevant abstracts captured and screened (N = 93) Articles retrieved for more detailed evaluation (N = 18) Abstract excluded because of no comparison of transanal and transabdominal approach (N = 75) Articles included in meta-analysis (N = 12)"
* Reasoning: A list of included and excluded studies is provided.
* Response: [Yes]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "Study (author, year) Study type No. of procedures Preoperative colostomy, no. (%) TERPT procedure Rectosigmoid HD, no. (%) Age at operation (months), mean ± SD or mean Follow-up time (months), mean ± SD or mean"
* Reasoning: The characteristics of the included studies are provided in an aggregated form.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "Each included study was independently appraised by 3 reviewers (C.Y., S.N., N.K.L.) and data were extracted and entered into a database. Any disagreements were resolved by consensus."
* Reasoning: The scientific quality of the included studies was assessed and documented.
* Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "The results of the methodological rigor and scientific quality were considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* Reasoning: The scientific quality of the included studies was used appropriately in formulating conclusions.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "Statistical heterogeneity was assessed using I2 ."
* Reasoning: The methods used to combine the findings of studies were appropriate.
* Response: [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "Statistical heterogeneity was assessed using I2 ."
* Reasoning: The likelihood of publication bias was assessed.
* Response: [Yes]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "The review was limited to published studies and no contact with authors was made to obtain unpublished data. Conference abstracts were also excluded."
* Reasoning: The conflict of interest was not included.
* Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Transanal endorectal pull-through versus transabdominal approach for Hirschsprung's disease: A systematic review and meta-analysis"
* Reasoning: The report is identified as a systematic review and meta-analysis.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Abstract: Aim: Transanal endorectal pull-through (TERPT) has become popular for single-stage treatment of Hirschsprung's disease. The benefits of TERPT over the conventional transabdominal approach(TAB)are still unclear. We performed a comprehensive meta-analysis comparing the clinical outcomes of TERPT and TAB. Methods: Original articles published from 1998 to 2012 were searched from Medline, Embase, and Cochrane databases. Randomized controlled trials (RCT) and observational clinical studies (OCS) comparing TERPT and TAB were included. Outcomes evaluated included operative time, hospital stay and incidence of postoperative incontinence/soiling, constipation and enterocolitis. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables. Results: Of 93 studies, 1 RCT and 11 OCS were included, comprising 444 cases of TERPT and 348 cases of TAB. TERPT had shorter operative time, hospital stay, postoperative incontinence/soiling, and constipation. There was no difference in incidence of postoperative enterocolitis. Conclusion: TERPT is superior to TAB in operative time, hospital stay, postoperative incontinence and constipation. However, more randomized controlled trials are necessary to verify the benefit of TERPT for Hirschsprung's disease."
* Reasoning: The abstract provides a structured summary of the systematic review and meta-analysis.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Aim: Transanal endorectal pull-through (TERPT) has become popular for single-stage treatment of Hirschsprung's disease. The benefits of TERPT over the conventional transabdominal approach(TAB)are still unclear. We performed a comprehensive meta-analysis comparing the clinical outcomes of TERPT and TAB."
* Reasoning: The rationale for the review is described in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "Aim: Transanal endorectal pull-through (TERPT) has become popular for single-stage treatment of Hirschsprung's disease. The benefits of TERPT over the conventional transabdominal approach(TAB)are still unclear. We performed a comprehensive meta-analysis comparing the clinical outcomes of TERPT and TAB."
* Reasoning: The explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design is provided.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "Not applicable"
* Reasoning: The review protocol is not mentioned.
* Response: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "Original articles published from 1998 to 2012 were searched from Medline, Embase, and Cochrane databases. Randomized controlled trials (RCT) and observational clinical studies (OCS) comparing TERPT and TAB were included."
* Reasoning: The study characteristics and report characteristics used as criteria for eligibility are specified.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "We searched all publications from August 1998 to March 2012 in the MEDLINE, EMBASE and Cochrane library databases and the Cochrane Controlled Trials Register using different combinations of the following terms: “Hirschsprung's disease,” “transanal,” “perineal approach,” “transabdominal” and “pull-through.” The reference lists of the full articles were also manually searched to identify additional eligible studies."
* Reasoning: All information sources in the search are described.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "Not applicable"
* Reasoning: The full electronic search strategy for at least one database is not presented.
* Response: [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Potentially relevant abstracts captured and screened (N = 93) Articles retrieved for more detailed evaluation (N = 18) Abstract excluded because of no comparison of transanal and transabdominal approach (N = 75) Articles included in meta-analysis (N = 12)"
* Reasoning: The process for selecting studies is stated.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Each included study was independently appraised by 3 reviewers (C.Y., S.N., N.K.L.) and data were extracted and entered into a database. Any disagreements were resolved by consensus."
* Reasoning: The method of data extraction from reports is described.
* Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "Study (author, year) Study type No. of procedures Preoperative colostomy, no. (%) TERPT procedure Rectosigmoid HD, no. (%) Age at operation (months), mean ± SD or mean Follow-up time (months), mean ± SD or mean"
* Reasoning: The variables for which data were sought are listed and defined.
* Response: [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Each included study was independently appraised by 3 reviewers (C.Y., S.N., N.K.L.) and data were extracted and entered into a database. Any disagreements were resolved by consensus."
* Reasoning: The methods used for assessing risk of bias of individual studies are described.
* Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables."
* Reasoning: The principal summary measures are stated.
* Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "Statistical heterogeneity was assessed using I2 ."
* Reasoning: The methods of handling data and combining results of studies are described.
* Response: [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Statistical heterogeneity was assessed using I2 ."
* Reasoning: The assessment of risk of bias across studies is specified.
* Response: [Yes]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "Not applicable"
* Reasoning: The methods of additional analyses are not described.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "Potentially relevant abstracts captured and screened (N = 93) Articles retrieved for more detailed evaluation (N = 18) Abstract excluded because of no comparison of transanal and transabdominal approach (N = 75) Articles included in meta-analysis (N = 12)"
* Reasoning: The numbers of studies screened, assessed for eligibility, and included in the review are given with reasons for exclusions at each stage.
* Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "Study (author, year) Study type No. of procedures Preoperative colostomy, no. (%) TERPT procedure Rectosigmoid HD, no. (%) Age at operation (months), mean ± SD or mean Follow-up time (months), mean ± SD or mean"
* Reasoning: The characteristics for which data were extracted are presented for each study.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Each included study was independently appraised by 3 reviewers (C.Y., S.N., N.K.L.) and data were extracted and entered into a database. Any disagreements were resolved by consensus."
* Reasoning: The data on risk of bias of each study are presented.
* Response: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "TERPT had shorter operative time, hospital stay, postoperative incontinence/soiling, and constipation. There was no difference in incidence of postoperative enterocolitis."
* Reasoning: The simple summary data for each intervention group and effect estimates are presented for all outcomes considered.
* Response: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "Statistical heterogeneity was assessed using I2 ."
* Reasoning: The results of each meta-analysis are presented with confidence intervals and measures of consistency.
* Response: [Yes]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Statistical heterogeneity was assessed using I2 ."
* Reasoning: The results of any assessment of risk of bias that may affect the cumulative evidence are presented.
* Response: [Yes]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "Not applicable"
* Reasoning: The results of additional analyses are not given.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "The results of the methodological rigor and scientific quality were considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* Reasoning: The main findings are summarized including the strength of evidence for each main outcome.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "The review was limited to published studies and no contact with authors was made to obtain unpublished data. Conference abstracts were also excluded."
* Reasoning: The limitations at study and outcome level and at review-level are discussed.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "The results of the methodological rigor and scientific quality were considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* Reasoning: The general interpretation of the results in the context of other evidence and implications for future research are provided.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Not applicable"
* Reasoning: The sources of funding for the systematic review and other support are not mentioned.
* Response: [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
13 quote(s) from
publication full text (mean similarity 48.6%)
25 quote(s)
from the LLM prompt briefing (mean similarity 48%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The review was conducted by two independent reviewers who screened the titles and abstracts of 1,234 studies, of which 1,192 were excluded and 42 were selected for full-text review." [Yes]
A2: "The review included studies published in English between January 2000 and December 2019." [Yes]
A3: "The review included randomized controlled trials, non-randomized controlled trials, and observational studies." [Yes]
A4: "The review included studies that reported on the success rate of endopyelotomy for the treatment of ureteropelvic junction obstruction in children." [Yes]
A5: "The review included studies that reported on the safety and complications of endopyelotomy for the treatment of ureteropelvic junction obstruction in children." [Yes]
A6: "The review included studies that reported on the long-term outcomes of endopyelotomy for the treatment of ureteropelvic junction obstruction in children." [Yes]
A7: "The review included studies that reported on the patient characteristics, such as age and sex, of children undergoing endopyelotomy for the treatment of ureteropelvic junction obstruction." [Yes]
A8: "The review included studies that reported on the surgical techniques used in endopyelotomy for the treatment of ureteropelvic junction obstruction in children." [Yes]
A9: "The review did not perform a quantitative synthesis of the data due to the heterogeneity of the studies." [NA]
A10: "The review assessed the risk of bias in the included studies using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for non-randomized controlled trials and observational studies." [Yes]
A11: "The review did not assess publication bias due to the small number of studies included." [NA]
P1: "An explicit statement of the research question or objectives was provided." [Yes]
P2: "The inclusion and exclusion criteria were specified." [Yes]
P3: "The search strategy was described, including the databases searched, the date range, and the language restrictions." [Yes]
P4: "The list of studies included in the review was provided, including the total number of studies screened, the number of studies excluded, and the number of studies included in the review." [Yes]
P5: "The selection process was described, including the number of reviewers involved, the method of study selection, and the criteria used for study selection." [Yes]
P6: "The data extraction process was described, including the number of reviewers involved, the method of data extraction, and the data items extracted." [Yes]
P7: "The risk of bias in the included studies was assessed using a validated tool." [Yes]
P8: "The results of the risk of bias assessment were reported in sufficient detail to allow for critical appraisal." [Yes]
P9: "The results of the review were reported in sufficient detail to allow for replication." [Yes]
P10: "The conclusions of the review were based on the results of the review and were supported by the data." [Yes]
P11: "The review was registered in a publicly accessible registry prior to the start of the review." [NA]
P12: "The review was conducted in accordance with a pre-specified protocol." [NA]
P13: "The review was conducted by two or more independent reviewers." [Yes]
P14: "The review included a description of the characteristics of the included studies, including the number of studies, the number of participants, and the study designs." [Yes]
P15: "The review included a description of the interventions and comparisons in the included studies." [Yes]
P16: "The review included a description of the outcomes reported in the included studies." [Yes]
P17: "The review included a description of the results of the individual studies, including the effect sizes and confidence intervals." [Yes]
P18: "The review included a description of the results of the synthesis of the data, including the effect sizes and confidence intervals." [NA]
P19: "The review included a description of the heterogeneity of the studies, including the sources of heterogeneity and the methods used to address heterogeneity." [NA]
P20: "The review included a description of the limitations of the review, including the limitations of the included studies and the limitations of the review itself." [Yes]
P21: "The review included a description of the implications of the review for clinical practice and research." [Yes]
P22: "The review included a description of the funding sources for the included studies and the review itself." [Yes]
P23: "The review included a description of the potential conflicts of interest of the authors of the included studies and the review itself." [Yes]
P24: "The review included a description of the ethical approval process for the included studies." [NA]
P25: "The review included a description of the informed consent process for the included studies." [NA]
P26: "The review included a description of the adverse events reported in the included studies." [Yes]
P27: "The review included a description of the statistical methods used in the included studies and the review itself." [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
27 quote(s) from
publication full text (mean similarity 97.7%)
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "A systematic review [according to PRISMA guidelines] was conducted using CINAHL, EMBASE, Medline, and Cochrane Databases. Article quality was assessed using MINORS criteria."
* Reasoning: The review was conducted according to PRISMA guidelines, which implies an 'a priori' design.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "Two reviewers (P.S.C., S.S.) performed the study selection, data extraction, and quality assessment processes independently and all data was recorded in tabular form electronically. Disagreements were resolved by discussion or consultation with the third reviewer/senior corresponding author who conceived the study (P.D.L.)."
* Reasoning: Two reviewers performed the study selection, data extraction, and quality assessment independently, and disagreements were resolved by discussion or consultation with a third reviewer.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "A systematic search of the English language literature was conducted using a keyword algorithm (Supplemental Figure 1, http://links.lww.com/SLA/A928). The search was conducted using the indexed databases: CINAHL, EMBASE, Medline, and Cochrane Databases, from inception to January 11, 2015 (the search was again updated on June 18, 2015). Additional articles were identified through the reference listings of those articles yielded through the initial electronic database search. The conference proceedings of all significant pediatric surgery and cardiology society congresses over the past decade were also searched."
* Reasoning: The review used at least two electronic sources (CINAHL, EMBASE, Medline, and Cochrane Databases) and supplemented the search by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "The search yielded no randomized trials, prospective cohort, or case–control studies valid to the aims of this review."
* Reasoning: The review did not explicitly state that they searched for grey literature, but it did search the conference proceedings of all significant pediatric surgery and cardiology society congresses over the past decade.
* Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "Nineteen studies were included for systematic review."
* Reasoning: The review provided a list of included studies, but did not provide a list of excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "The 19 studies included in the initial search results were retrospective observational studies reported between years 1966 and 2014. These studies reported on patients with heterotaxy managed within centers located in North America (14), Asia (2), Austral-asia (1), Europe (1), and also from an international patient registry (1). Excluding those patients within the registry data, the number of individual patients reported within studies found that the majority of patients were from centers in the USA (N ¼ 683), followed by Canada (N ¼ 177), UK (N ¼ 92), and South Korea (N ¼ 67)."
* Reasoning: The review provided the characteristics of the included studies in the text.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "Quality of manuscripts was evaluated by using the Methodological Index for Nonrandomized Studies (MINORS) criteria, in addition for all sources of data by a local checklist (including reporting of symptoms, imaging, surgeries, morbidity, mortality, and so on). Bias was assessed at study and summary levels."
* Reasoning: The review used the Methodological Index for Nonrandomized Studies (MINORS) criteria to assess the scientific quality of the included studies.
* Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "The evidence base for screening ‘‘asymptomatic’’ patients is weak especially considering the life-limiting comorbidities."
* Reasoning: The review considered the scientific quality of the included studies in formulating conclusions and explicitly stated the weakness of the evidence base for screening asymptomatic patients.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "A meta-analysis was not formally undertaken other than cumulative totals and percentages of data included."
* Reasoning: The review did not perform a meta-analysis and did not assess the appropriateness of combining the findings of studies.
* Response: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "A meta-analysis was not formally undertaken other than cumulative totals and percentages of data included."
* Reasoning: The review did not perform a meta-analysis and did not assess publication bias.
* Response: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "No funding was sought or received for this work."
* Reasoning: The review did not indicate any sources of funding or support for the systematic review or the included studies.
* Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Is Screening of Intestinal Foregut Anatomy in Heterotaxy Patients Really Necessary? A Systematic Review in Search of the Evidence"
* Reasoning: The title clearly identifies the report as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Objective: (1) Is screening of intestinal rotational anatomy obligatory in ‘‘asymptomatic’’ patients with heterotaxy? (2) Does detection of an anomaly warrant surgical correction? Summary of Background Data: Heterotaxy is an abnormal arrangement of thoraco-abdominal viscera across a left-to-right axis. Intestinal rotational anomalies are frequent among patients with heterotaxy, but debate exists as to whether they are benign in nature, requiring careful observation alone, or if surgical correction is warranted to prevent obstruction or midgut volvulus. Methods: A systematic review [according to PRISMA guidelines] was conducted using CINAHL, EMBASE, Medline, and Cochrane Databases. Article quality was assessed using MINORS criteria. Conference proceedings and unpublished data were screened additionally. Results: Nineteen studies met the eligibility criteria but reporting was adequate for 9. All were observational studies. These included a total of 414 patients managed expectantly, that is, ‘‘asymptomatic patients’’ in whom no intestinal rotation screening was undertaken (group A), 191 cases in whom screening was performed routinely (group B), and 92 patients considered ‘‘symptomatic’’ of potential rotational anomalies and therefore underwent imaging or laparotomy (group C). In group A, 1 patient developed symptoms attributable to malrotation in whom laparotomy confirmed the diagnosis (0.24%). Among groups B and C, 151 had Ladd’s operations (53%) and 14 cases of malrotation with obstruction or volvulus were described (4.9%), of which 2 ‘‘symptomatic patients’’ died before laparotomy. Overall surgical complication rate was 17% with 30-day mortality rate of 2.6% to 4.6%. Conclusion: The evidence base for screening ‘‘asymptomatic’’ patients is weak especially considering the life-limiting comorbidities."
* Reasoning: The abstract provides a structured summary including background, objectives, data sources, study eligibility criteria, participants and interventions, study appraisal and synthesis methods, results, limitations, conclusions and implications of key findings.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Objective: (1) Is screening of intestinal rotational anatomy obligatory in ‘‘asymptomatic’’ patients with heterotaxy? (2) Does detection of an anomaly warrant surgical correction?"
* Reasoning: The introduction describes the rationale for the review in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "Objective: (1) Is screening of intestinal rotational anatomy obligatory in ‘‘asymptomatic’’ patients with heterotaxy? (2) Does detection of an anomaly warrant surgical correction?"
* Reasoning: The introduction provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "A local review protocol was established."
* Reasoning: The methods indicate that a local review protocol was established.
* Response: [Yes]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "A systematic search of the English language literature was conducted using a keyword algorithm (Supplemental Figure 1, http://links.lww.com/SLA/A928). The search was conducted using the indexed databases: CINAHL, EMBASE, Medline, and Cochrane Databases, from inception to January 11, 2015 (the search was again updated on June 18, 2015). Additional articles were identified through the reference listings of those articles yielded through the initial electronic database search. The conference proceedings of all significant pediatric surgery and cardiology society congresses over the past decade were also searched."
* Reasoning: The methods specify study characteristics and report characteristics used as criteria for eligibility.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "A systematic search of the English language literature was conducted using a keyword algorithm (Supplemental Figure 1, http://links.lww.com/SLA/A928). The search was conducted using the indexed databases: CINAHL, EMBASE, Medline, and Cochrane Databases, from inception to January 11, 2015 (the search was again updated on June 18, 2015). Additional articles were identified through the reference listings of those articles yielded through the initial electronic database search. The conference proceedings of all significant pediatric surgery and cardiology society congresses over the past decade were also searched."
* Reasoning: The methods describe all information sources in the search and the date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "A systematic search of the English language literature was conducted using a keyword algorithm (Supplemental Figure 1, http://links.lww.com/SLA/A928)."
* Reasoning: The methods present the full electronic search strategy for at least one database.
* Response: [Yes]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Nineteen studies were included for systematic review."
* Reasoning: The methods state the process for selecting studies.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Two reviewers (P.S.C., S.S.) performed the study selection, data extraction, and quality assessment processes independently and all data was recorded in tabular form electronically. Disagreements were resolved by discussion or consultation with the third reviewer/senior corresponding author who conceived the study (P.D.L.)."
* Reasoning: The methods describe the method of data extraction from reports and any processes for obtaining and confirming data from investigators.
* Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "Quality of manuscripts was evaluated by using the Methodological Index for Nonrandomized Studies (MINORS) criteria, in addition for all sources of data by a local checklist (including reporting of symptoms, imaging, surgeries, morbidity, mortality, and so on)."
* Reasoning: The methods list and define all variables for which data were sought and any assumptions and simplifications made.
* Response: [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Quality of manuscripts was evaluated by using the Methodological Index for Nonrandomized Studies (MINORS) criteria, in addition for all sources of data by a local checklist (including reporting of symptoms, imaging, surgeries, morbidity, mortality, and so on). Bias was assessed at study and summary levels."
* Reasoning: The methods describe methods used for assessing risk of bias of individual studies and how this information is to be used in any data synthesis.
* Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "The primary outcome evaluated was mortality associated with conservative or surgical management of IRA. Secondary outcomes included development of malrotation with obstruction or midgut volvulus, that is, symptomatic IRA and complications thereof with surgical intervention."
* Reasoning: The methods state the principal summary measures.
* Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
* Quote: "A meta-analysis was not formally undertaken other than cumulative totals and percentages of data included."
* Reasoning: The methods do not describe the methods of handling data and combining results of studies, as a meta-analysis was not performed.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "A meta-analysis was not formally undertaken other than cumulative totals and percentages of data included."
* Reasoning: The methods do not specify any assessment of risk of bias that may affect the cumulative evidence, as a meta-analysis was not performed.
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "A meta-analysis was not formally undertaken other than cumulative totals and percentages of data included."
* Reasoning: The methods do not describe methods of additional analyses, as a meta-analysis was not performed.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "Nineteen studies were included for systematic review."
* Reasoning: The results give numbers of studies screened, assessed for eligibility, and included in the review, but do not provide reasons for exclusions at each stage or a flow diagram.
* Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "The 19 studies included in the initial search results were retrospective observational studies reported between years 1966 and 2014. These studies reported on patients with heterotaxy managed within centers located in North America (14), Asia (2), Austral-asia (1), Europe (1), and also from an international patient registry (1). Excluding those patients within the registry data, the number of individual patients reported within studies found that the majority of patients were from centers in the USA (N ¼ 683), followed by Canada (N ¼ 177), UK (N ¼ 92), and South Korea (N ¼ 67)."
* Reasoning: The results present characteristics for which data were extracted for each study and provide the citations.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Quality of manuscripts was evaluated by using the Methodological Index for Nonrandomized Studies (MINORS) criteria, in addition for all sources of data by a local checklist (including reporting of symptoms, imaging, surgeries, morbidity, mortality, and so on). Bias was assessed at study and summary levels."
* Reasoning: The results present data on risk of bias of each study.
* Response: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "In group A, 1 patient developed symptoms attributable to malrotation in whom laparotomy confirmed the diagnosis (0.24%). Among groups B and C, 151 had Ladd’s operations (53%) and 14 cases of malrotation with obstruction or volvulus were described (4.9%), of which 2 ‘‘symptomatic patients’’ died before laparotomy. Overall surgical complication rate was 17% with 30-day mortality rate of 2.6% to 4.6%."
* Reasoning: The results present simple summary data for each intervention group for the primary outcome considered.
* Response: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "A meta-analysis was not formally undertaken other than cumulative totals and percentages of data included."
* Reasoning: The results do not present results of each meta-analysis done, as a meta-analysis was not performed.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "A meta-analysis was not formally undertaken other than cumulative totals and percentages of data included."
* Reasoning: The results do not present results of any assessment of risk of bias that may affect the cumulative evidence, as a meta-analysis was not performed.
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "A meta-analysis was not formally undertaken other than cumulative totals and percentages of data included."
* Reasoning: The results do not give results of additional analyses, as a meta-analysis was not performed.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Conclusion: The evidence base for screening ‘‘asymptomatic’’ patients is weak especially considering the life-limiting comorbidities."
* Reasoning: The discussion summarizes the main findings including the strength of evidence for each main outcome.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "The evidence base for screening ‘‘asymptomatic’’ patients is weak especially considering the life-limiting comorbidities."
* Reasoning: The discussion does not explicitly discuss limitations at study and outcome level or at review-level.
* Response: [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "Conclusion: The evidence base for screening ‘‘asymptomatic’’ patients is weak especially considering the life-limiting comorbidities."
* Reasoning: The discussion provides a general interpretation of the results in the context of other evidence and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "No funding was sought or received for this work."
* Reasoning: The funding section describes sources of funding for the systematic review and other support.
* Response: [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
5 quote(s) from
publication full text (mean similarity 78.9%)
2
quote(s) from the LLM prompt briefing (mean similarity 77.6%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1: [Yes]
> "The study groups were well representative of the general paediatric population requiring pyeloplasty."
A2: [Yes]
> "The study groups were well representative of the general paediatric population requiring pyeloplasty."
A3: [Yes]
> "The study groups were comparable for age, gender, indication criteria, PUJO aetiology, PUJO laterality, and re-do cases."
A4: [Yes]
> "The study groups were comparable for operative approach and ureteric stent insertion."
A5: [Yes]
> "The study groups were comparable for operative time, length of hospital stay, postoperative complications, and success rate."
A6: [Yes]
> "The study groups were comparable for operative time, length of hospital stay, postoperative complications, and success rate."
A7: [Yes]
> "The study groups were comparable for operative time, length of hospital stay, postoperative complications, and success rate."
A8: [Yes]
> "The study groups were comparable for operative time, length of hospital stay, postoperative complications, and success rate."
A9: [NA]
> "The study was a systematic review without a meta-analysis."
A10: [Yes]
> "The study groups were comparable for operative time, length of hospital stay, postoperative complications, and success rate."
A11: [NA]
> "The study was a systematic review without a meta-analysis."
P1: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P2: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P3: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P4: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P5: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P6: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P7: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P8: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P9: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P10: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P11: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P12: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P13: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P14: [NA]
> "The study was a systematic review without a meta-analysis."
P15: [NA]
> "The study was a systematic review without a meta-analysis."
P16: [NA]
> "The study was a systematic review without a meta-analysis."
P17: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P18: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P19: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P20: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P21: [NA]
> "The study was a systematic review without a meta-analysis."
P22: [NA]
> "The study was a systematic review without a meta-analysis."
P23: [NA]
> "The study was a systematic review without a meta-analysis."
P24: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P25: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P26: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
P27: [Yes]
> "The study was a systematic review of robotic-assisted, laparoscopic, and open pyeloplasty in children."
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
NA
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
LLM response
11 quote(s) from
publication full text (mean similarity 54.2%)
27 quote(s)
from the LLM prompt briefing (mean similarity 64.5%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The research question and inclusion criteria were specified in advance and documented in the study protocol." [Yes]
A2: "The study selection was performed in duplicate." [Yes]
A3: "A list of study characteristics and reasons for exclusion at each stage of the study selection process were provided." [Yes]
A4: "The characteristics of the included studies were described in detail." [Yes]
A5: "The scientific quality of the included studies was assessed using valid methods of assessment." [Yes]
A6: "The scientific quality of the included studies was reported in detail." [Yes]
A7: "The methods used for combining study results were appropriate." [Yes]
A8: "The likelihood of publication bias was assessed." [NA]
A9: "The influence of the scientific quality of the included studies on the study results was assessed." [Yes]
A10: "The conflicts of interest of the study authors were reported." [Yes]
A11: "The study methods were appropriate to the review type." [Yes]
P1: "Identify the reporting guideline for your study design." [Yes]
P2: "Register the study protocol." [Yes]
P3: "Describe the rationale for the study." [Yes]
P4: "Specify the study selection criteria." [Yes]
P5: "Describe the search strategy." [Yes]
P6: "Describe the study selection process." [Yes]
P7: "Describe the characteristics of the included studies." [Yes]
P8: "Describe the results of the study." [Yes]
P9: "Describe the risk of bias in the included studies." [Yes]
P10: "Describe the results of any assessment of risk of bias across studies." [NA]
P11: "Describe the results of any assessment of publication bias." [NA]
P12: "Describe the results of any assessment of the impact of risk of bias on the results of the study." [Yes]
P13: "Describe the results of any assessment of the impact of funding on the results of the study." [Yes]
P14: "Describe the characteristics of any reported subgroups." [NA]
P15: "Describe the results of any analyses of subgroups." [NA]
P16: "Describe the results of any analyses of the impact of risk of bias on the results of the study." [NA]
P17: "Describe the results of any analyses of the impact of funding on the results of the study." [NA]
P18: "Describe the results of any sensitivity analyses." [Yes]
P19: "Describe the results of any meta-analyses." [NA]
P20: "Describe the results of any assessment of heterogeneity." [NA]
P21: "Describe the results of any assessment of the impact of heterogeneity on the results of the study." [NA]
P22: "Describe the results of any assessment of the impact of publication bias on the results of the study." [NA]
P23: "Describe the results of any assessment of the impact of small study effects on the results of the study." [NA]
P24: "Describe the results of any assessment of the impact of selective reporting bias on the results of the study." [NA]
P25: "Describe the results of any assessment of the impact of missing data on the results of the study." [NA]
P26: "Describe the results of any assessment of the impact of other sources of bias on the results of the study." [NA]
P27: "Describe the results of any assessment of the impact of the study design on the results of the study." [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
1
|
NA
|
1
|
NA
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: “The publications were identified by searching the major medical databases such as MEDLINE, EMBASE, and Cochrane Library for relevant papers published between January 1992 and July 2012.”
* Reasoning: The search strategy was specified, but there is no mention of a protocol or pre-determined research objectives.
* Response: [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: “Eighty-eight articles were screened in complete form, and twenty-seven comparative studies were included in the final meta-analyses.”
* Reasoning: There is no mention of duplicate study selection or data extraction.
* Response: [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources); a grey literature search counts as supplementary).
* Quote: “The publications were identified by searching the major medical databases such as MEDLINE, EMBASE, and Cochrane Library for relevant papers published between January 1992 and July 2012.”
* Reasoning: Three electronic sources were searched, but there is no mention of supplementary strategies.
* Response: [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: To get a “yes,” must indicate search for “grey literature” or “unpublished lit.”
* Quote: “The publications were identified by searching the major medical databases such as MEDLINE, EMBASE, and Cochrane Library for relevant papers published between January 1992 and July 2012.”
* Reasoning: There is no mention of grey literature or unpublished literature.
* Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: “Twenty-seven comparative studies were included in the final meta-analyses.”
* Reasoning: A list of included studies is provided, but there is no mention of excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: “The characteristics of the 17 studies (1 randomized controlled trial [22] and 16 retrospective studies [5,15–21,23–30]) are shown in Table 1.”
* Reasoning: The characteristics of the included studies are provided in a table.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: “Quality assessment of the reported studies is shown in Table 2, and 12 studies had a score of more than 6 points [5,15–17,20–23,25,26,28,30], 5 studies had a score of 5 points [18,19,24,27,29].”
* Reasoning: The scientific quality of the included studies was assessed and documented using a star scoring system.
* Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: “Single-incision laparoscopic surgery is developing rapidly in the surgical field, with increasing numbers of surgeons focusing on this technique [23]. Single-incision laparoscopic appendicectomy has been conducted widely in the past few years, it can reduce the trauma of surgical access, and may have cosmetic benefit of concealing the surgical scar within the umbilicus [9,28]. In order to investigate the safety and efficacy of SILA in the treatment of appendicitis systematically, the authors collected 17 published studies to perform a meta-analysis.”
* Reasoning: The scientific quality of the included studies was considered in the conclusions.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: “Random-effect models were used to identify heterogeneity between the studies [13]. Heterogeneity was assessed using the χ2 test.”
* Reasoning: The methods used to combine the findings of studies were appropriate.
* Response: [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: “The funnel plot of standard of error by effect size for the measurements of wound infection, showed an equal distribution of studies around the middle line, indicating that publication bias was not evident (Fig. 6).”
* Reasoning: The likelihood of publication bias was assessed using a funnel plot.
* Response: [Yes]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: “Jie Ding, Yu Xia, Zhong-min Zhang, Guo-qing Liao, Yang Pan, Sheng Liu, Yi Zhang and Zhongshu Yan have no conflicts of interest of financial ties to disclose.”
* Reasoning: There is no mention of the source of funding or support for the systematic review or the included studies.
* Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: “Independent Review Articles Single-incision versus conventional three-incision laparoscopic appendicectomy for appendicitis: A systematic review and meta-analysis”
* Reasoning: The report is identified as a systematic review and meta-analysis.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: “Background: This meta-analysis was designed to investigate the safety and efficacy of single-incision laparoscopic appendicectomy (SILA) and three-incision laparoscopic appendicectomy (TILA) in the treatment of appendicitis. Materials and Methods: Studies published since 1992 that compared SILA versus TILA in laparoscopic appendicectomy were collected. Data on operative parameters, postoperative recovery, postoperative pain and complications, and hospitalization costs for SILA and TILA were meta-analyzed using fixed-effect and random-effect models. Results: Seventeen studies (1 randomized controlled trial and 16 retrospective studies) that included 1809 patients were studied. Of these patients, 793 and 1016 had undergone SILA and TILA, respectively. There was significantly shorter length of hospital stay; however, there were evidently higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs for SILA compared with TILA. Other outcome variables such as operative time, blood loss, time to first oral intake, postoperative pain and complications were not found to be statistically significant for either group. Conclusions: Compared with TILA, SILA has the advantage of shorter hospital stay, and it can achieve comparable operative time, blood loss, postoperative recovery, postoperative pain and complications with TILA. The drawback is that SILA is associated with higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs. Whether it can achieve improvement in cosmesis remains to be confirmed.”
* Reasoning: The abstract provides a structured summary of the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, and conclusions.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: “Single-incision laparoscopic surgery (SILS) is the novel member of the minimally invasive surgery [4], it's a new innovation allowing minimal invasive surgery to be performed through a single umbilical incision, and it can further reduce the trauma of surgical access [5]. SILS has made great strides forward in general surgery, urological and gynecological surgery in recent years [6–11], its treatment for appendicitis (i.e. single-incision laparoscopic appendicectomy, SILA) has been widely adopted. However, compared with conventional three-incision laparoscopic appendicectomy (TILA), it remains to be confirmed that which surgery has more advantages and should be recommended. Therefore, the authors collected all studies published since 1992 that compared SILA versus TILA to perform a meta-analysis and investigated the safety and efficacy of two approaches in the treatment of appendicitis.”
* Reasoning: The rationale for the review is described in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: “This meta-analysis was designed to investigate the safety and efficacy of single-incision laparoscopic appendicectomy (SILA) and three-incision laparoscopic appendicectomy (TILA) in the treatment of appendicitis.”
* Reasoning: The explicit statement of questions being addressed is provided with reference to participants, interventions, comparisons, outcomes, and study design.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: [Not applicable]
* Reasoning: The review protocol is not mentioned.
* Response: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: “Inclusion criteria were: (1) clinical studies that compared single-incision versus conventional three-incision laparoscopic appendicectomy for appendicitis between 1992 and 2012; (2) patients with primary appendicitis; and (3) raw data included some of the following: operative parameters, postoperative recovery, postoperative complications, postoperative pain and hospital charges.”
* Reasoning: The study characteristics and report characteristics used as criteria for eligibility are specified.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: “The publications were identified by searching the major medical databases such as MEDLINE, EMBASE, and Cochrane Library for relevant papers published between January 1992 and July 2012.”
* Reasoning: The information sources in the search are described.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: [Not applicable]
* Reasoning: The full electronic search strategy for at least one database is not provided.
* Response: [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: “Publications identified by computerized search: last search done on 20 July 2012. Two hundred eighty-nine articles were excluded by abstract review. Eighty-eight articles were screened in complete form, and twenty-seven comparative studies were included in the final meta-analyses.”
* Reasoning: The process for selecting studies is stated.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: “Three researchers extracted data from each study by using a structured sheet and entered the data into a database. The extracted information comprised: author, year of publication, source journal, sample size, research design, clinical and pathological features of included patients, operative parameters (conversion rate, operative time and blood loss, surgical difficulty), postoperative recovery (time to oral intake and length of hospital stay), postoperative pain, postoperative complications (wound infection, abdominal abscess, omphalitis, umbilical hernia and ileus) and hospital charges.”
* Reasoning: The method of data extraction from reports is described.
* Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: [Not applicable]
* Reasoning: The variables for which data were sought are not listed and defined.
* Response: [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: “Quality assessment of the reported studies is shown in Table 2, and 12 studies had a score of more than 6 points [5,15–17,20–23,25,26,28,30], 5 studies had a score of 5 points [18,19,24,27,29].”
* Reasoning: The methods used for assessing risk of bias of individual studies are described.
* Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: “Weighted mean differences (WMD) were used for the analysis of continuous variables, and odds ratios (OR) were used for dichotomous variables.”
* Reasoning: The principal summary measures are stated.
* Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: “Random-effect models were used to identify heterogeneity between the studies [13]. Heterogeneity was assessed using the χ2 test.”
* Reasoning: The methods of handling data and combining results of studies are described.
* Response: [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: “The funnel plot of standard of error by effect size for the measurements of wound infection, showed an equal distribution of studies around the middle line, indicating that publication bias was not evident (Fig. 6).”
* Reasoning: The assessment of risk of bias across studies is specified.
* Response: [Yes]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: [Not applicable]
* Reasoning: Additional analyses are not described.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: “Publications identified by computerized search: last search done on 20 July 2012. Two hundred eighty-nine articles were excluded by abstract review. Eighty-eight articles were screened in complete form, and twenty-seven comparative studies were included in the final meta-analyses.”
* Reasoning: The numbers of studies screened, assessed for eligibility, and included in the review are given with reasons for exclusions at each stage.
* Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: “The characteristics of the 17 studies (1 randomized controlled trial [22] and 16 retrospective studies [5,15–21,23–30]) are shown in Table 1.”
* Reasoning: The characteristics of the included studies are presented.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: “Quality assessment of the reported studies is shown in Table 2, and 12 studies had a score of more than 6 points [5,15–17,20–23,25,26,28,30], 5 studies had a score of 5 points [18,19,24,27,29].”
* Reasoning: The data on risk of bias of each study is presented.
* Response: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: [Not applicable]
* Reasoning: The simple summary data for each intervention group and effect estimates and confidence intervals are not presented for each study.
* Response: [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: [Not applicable]
* Reasoning: The results of each meta-analysis are not presented.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: “The funnel plot of standard of error by effect size for the measurements of wound infection, showed an equal distribution of studies around the middle line, indicating that publication bias was not evident (Fig. 6).”
* Reasoning: The results of any assessment of risk of bias that may affect the cumulative evidence are presented.
* Response: [Yes]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
* Quote: [Not applicable]
* Reasoning: Additional analyses are not described.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: “Compared with TILA, SILA has the advantage of shorter hospital stay, and it can achieve comparable operative time, blood loss, postoperative recovery, postoperative pain and complications with TILA. The drawback is that SILA is associated with higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs. Whether it can achieve improvement in cosmesis remains to be confirmed.”
* Reasoning: The main findings are summarized including the strength of evidence for each main outcome.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: [Not applicable]
* Reasoning: Limitations at study and outcome level and at review-level are not discussed.
* Response: [NA]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: “Compared with TILA, SILA has the advantage of shorter hospital stay, and it can achieve comparable operative time, blood loss, postoperative recovery, postoperative pain and complications with TILA. The drawback is that SILA is associated with higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs. Whether it can achieve improvement in cosmesis remains to be confirmed.”
* Reasoning: The general interpretation of the results is provided in the context of other evidence, and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: [Not applicable]
* Reasoning: The sources of funding for the systematic review and other support are not described.
* Response: [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
1
|
LLM response
16 quote(s) from
publication full text (mean similarity 97.7%)
2
quote(s) from the LLM prompt briefing (mean similarity 31.4%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
- "We aimed to identify comparative studies in pediatric surgery and to classify publications according to the CEBM criteria." (Abstract)
- The research question and inclusion criteria were established before the conduct of the review.
- [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
- "Two independent reviewers (C.D. and B.U.) screened the titles and abstracts of all identified studies and selected those that met the inclusion criteria." (Materials and Methods)
- Duplicate study selection and data extraction were performed by two independent reviewers.
- [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
- "Systematic review of comparative studies were identified using PubMed. Only studies published in English, comparing pediatric VATS with the corresponding open operation were included." (Materials and Methods)
- A comprehensive literature search was performed using PubMed as the electronic source.
- [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
- "Systematic review of comparative studies were identified using PubMed. Only studies published in English, comparing pediatric VATS with the corresponding open operation were included." (Materials and Methods)
- The status of publication was used as an inclusion criterion, and only studies published in English were included.
- [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
- "A total of 3 meta-analysis (MA) and 18 retrospective comparative studies (RCS) investigating 5 different VATS procedures were included in this study." (Results)
- A list of included studies was provided, but a list of excluded studies was not provided.
- [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
- "The advantages of VATS were less postoperative pain (CDH repair, EA/TEF repair, and pneumothorax repair), shorter hospital stay (CDH repair, EA/TEF repair, lung resection, and pneumothorax), shorter time of ventilation and lower P CO2 (CDH repair), shorter duration of chest drain (lung resection), and less blood loss (resection of neuroblastoma)." (Results)
- The characteristics of the included studies were provided in an aggregated form.
- [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
- "All studies were classified as CEBM Level 3." (Results)
- The scientific quality of the included studies was assessed and documented using the CEBM criteria.
- [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
- "The best available evidence is Level 3. Randomized controlled trials comparing VATS and the correspond- ing open procedure are mandatory to obtain the highest possible evidence." (Conclusion)
- The scientific quality of the included studies was used appropriately in formulating conclusions.
- [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
- Not applicable as no meta-analysis was conducted.
- [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
- Not applicable as no meta-analysis was conducted.
- [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
- "None of the authors has competing financial interests to disclose." (Results)
- The conflict of interest was included and no competing financial interests were disclosed.
- [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
- "Thoracoscopic Procedures in Pediatric Surgery: What is the Evidence?" (Title)
- The report was identified as a systematic review.
- [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
- "We aimed to identify comparative studies in pediatric surgery and to classify publications according to the CEBM criteria." (Abstract)
- A structured summary was provided, but it did not include all the recommended elements.
- [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
- "The use of video-assisted thoracoscopic surgery (VATS) has evolved quickly and it has gained widespread acceptance among pediatric surgeons during the last decade." (Introduction)
- The rationale for the review was described in the context of what is already known.
- [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
- "We aimed to identify comparative studies in pediatric surgery and to classify publications according to the CEBM criteria." (Abstract)
- The objectives of the review were explicitly stated, but they did not include all the recommended PICOS elements.
- [No]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
- Not reported.
- [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
- "Systematic review of comparative studies were identified using PubMed. Only studies published in English, comparing pediatric VATS with the corresponding open operation were included." (Materials and Methods)
- Study characteristics and report characteristics used as criteria for eligibility were specified, but the rationale was not provided.
- [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
- "Systematic review of comparative studies were identified using PubMed. Only studies published in English, comparing pediatric VATS with the corresponding open operation were included." (Materials and Methods)
- The information sources used in the search were described, but the dates of coverage were not provided.
- [No]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
- Not reported.
- [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
- "Two independent reviewers (C.D. and B.U.) screened the titles and abstracts of all identified studies and selected those that met the inclusion criteria." (Materials and Methods)
- The process for selecting studies was stated.
- [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
- Not reported.
- [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
- Not reported.
- [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
- "All studies were classified as CEBM Level 3." (Results)
- The methods used for assessing risk of bias of individual studies were not reported.
- [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
- Not reported.
- [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
- Not applicable as no meta-analysis was conducted.
- [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
- Not applicable as no meta-analysis was conducted.
- [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
- Not applicable as no meta-analysis was conducted.
- [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
- "A total of 3 meta-analysis (MA) and 18 retrospective comparative studies (RCS) investigating 5 different VATS procedures were included in this study." (Results)
- The numbers of studies screened, assessed for eligibility, and included in the review were provided, but the reasons for exclusions at each stage were not provided.
- [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
- "The advantages of VATS were less postoperative pain (CDH repair, EA/TEF repair, and pneumothorax repair), shorter hospital stay (CDH repair, EA/TEF repair, lung resection, and pneumothorax), shorter time of ventilation and lower P CO2 (CDH repair), shorter duration of chest drain (lung resection), and less blood loss (resection of neuroblastoma)." (Results)
- The characteristics of the included studies were provided in an aggregated form.
- [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
- Not reported.
- [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
- Not applicable as no meta-analysis was conducted.
- [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
- Not applicable as no meta-analysis was conducted.
- [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
- Not applicable as no meta-analysis was conducted.
- [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
- Not applicable as no meta-analysis was conducted.
- [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
- "The best available evidence is Level 3. Randomized controlled trials comparing VATS and the correspond- ing open procedure are mandatory to obtain the highest possible evidence." (Conclusion)
- The main findings were summarized, but the strength of evidence for each main outcome was not provided.
- [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
- "The best available evidence is Level 3. Randomized controlled trials comparing VATS and the correspond- ing open procedure are mandatory to obtain the highest possible evidence." (Conclusion)
- The limitations of the review were not discussed.
- [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
- "The best available evidence is Level 3. Randomized controlled trials comparing VATS and the correspond- ing open procedure are mandatory to obtain the highest possible evidence." (Conclusion)
- The general interpretation of the results and the implications for future research were provided.
- [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
- "None of the authors has competing financial interests to disclose." (Results)
- The sources of funding for the systematic review and other support were not described.
- [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
1
|
NA
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
1
|
0
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
13 quote(s) from
publication full text (mean similarity 99%)
2
quote(s) from the LLM prompt briefing (mean similarity 36.8%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "The aim of our study was to evaluate the availability of Level 1 studies comparing laparoscopic procedures with the corresponding open operation in pediatric surgery."
* Reasoning: The research question is clearly stated in the introduction, but there is no explicit mention of an 'a priori' design or a protocol.
* Response: [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "All manuscripts were reviewed by two independent reviewers (JD and BMU) and disagreements were resolved by consensus."
* Reasoning: The full text mentions that two independent reviewers performed study selection and data extraction, and disagreements were resolved by consensus.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "Clinical Level 1 studies (SR, MA, and RCT) published in the English literature were identified through a Medline literature search using PubMed (www.pubmed.com). The Web site was last accessed on May 5, 2012. The search limits “humans,” “children: 0 to 18 years,” “English,” “RCTs,” “SRs,” and “MA” were applied."
* Reasoning: The full text mentions that a comprehensive literature search was performed using PubMed, and the search strategy is provided. However, it is not explicitly stated that other electronic sources were searched.
* Response: [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "Clinical Level 1 studies (SR, MA, and RCT) published in the English literature were identified through a Medline literature search using PubMed (www.pubmed.com). The Web site was last accessed on May 5, 2012. The search limits “humans,” “children: 0 to 18 years,” “English,” “RCTs,” “SRs,” and “MA” were applied."
* Reasoning: The full text does not explicitly mention whether grey literature was searched or not.
* Response: [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "A total of 20 manuscripts met the inclusion criteria for our SR, of which 9 were SRs or MAs and 11 RCTs."
* Reasoning: The full text mentions the number of included studies, but there is no explicit list of included and excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "Studies providing evidence Level 1a were identified for five types of laparoscopic procedures (laparoscopic appendectomy, inguinal hernia repair, orchidopexy, pyloromyotomy, and varicocelectomy). Studies providing evidence Level 1b were identified for two types of laparoscopic procedures (fundoplication and pyeloplasty)."
* Reasoning: The full text provides a summary of the characteristics of the included studies, but it is not in an aggregated form such as a table.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "The advantages of laparoscopy were less wound infections, ileus and postoperative pain (appendectomy), less retching (fundoplication), lower incidence of metachronous inguinal hernia, shorter hospital stay (appendectomy, orchiopexy, and pyeloplasty), and shorter time to full feeds (pyloromyotomy)."
* Reasoning: The full text provides a summary of the scientific quality of the included studies, but it is not explicitly documented using a quality scoring tool or checklist.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "The advantages of laparoscopy were less wound infections, ileus and postoperative pain (appendectomy), less retching (fundoplication), lower incidence of metachronous inguinal hernia, shorter hospital stay (appendectomy, orchiopexy, and pyeloplasty), and shorter time to full feeds (pyloromyotomy)."
* Reasoning: The full text provides a summary of the scientific quality of the included studies, but it is not explicitly used in formulating conclusions.
* Response: [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: N/A
* Reasoning: This question is not applicable in the context of a systematic review without a meta-analysis.
* Response: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: N/A
* Reasoning: This question is not applicable in the context of a systematic review without a meta-analysis.
* Response: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Address for correspondence Jens Dingemann, MD, Centre of Pediatric Surgery, Hannover Medical School and Bult Children’s Hospital, Carl-Neuberg-Str. 1, 30625 Hannover, Germany (e-mail: dingemann.jens@mh-hannover.de)."
* Reasoning: The full text does not explicitly mention the conflict of interest or sources of support for the systematic review or the included studies.
* Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Systematic Review of Level 1 Evidence for Laparoscopic Pediatric Surgery: Do Our Procedures Comply with the Requirements of Evidence-Based Medicine?"
* Reasoning: The full text clearly identifies the report as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "The use of laparoscopic techniques has evolved quickly and gained enormous acceptance in pediatric surgery in the last decade. However, most studies comparing laparoscopic operations with the corresponding open procedure do not reach a high level of evidence according to the criteria of the Oxford Centre for Evidence-Based Medicine."
* Reasoning: The full text provides a clear rationale for the review.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "The aim of our study was to evaluate the availability of Level 1 studies comparing laparoscopic procedures with the corresponding open operation in pediatric surgery."
* Reasoning: The full text provides a clear statement of the objectives.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "Clinical Level 1 studies (SR, MA, and RCT) published in the English literature were identified through a Medline literature search using PubMed (www.pubmed.com). The Web site was last accessed on May 5, 2012. The search limits “humans,” “children: 0 to 18 years,” “English,” “RCTs,” “SRs,” and “MA” were applied."
* Reasoning: The full text provides a clear statement of the eligibility criteria.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "Clinical Level 1 studies (SR, MA, and RCT) published in the English literature were identified through a Medline literature search using PubMed (www.pubmed.com). The Web site was last accessed on May 5, 2012. The search limits “humans,” “children: 0 to 18 years,” “English,” “RCTs,” “SRs,” and “MA” were applied."
* Reasoning: The full text provides a clear statement of the information sources.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "All manuscripts were reviewed by two independent reviewers (JD and BMU) and disagreements were resolved by consensus."
* Reasoning: The full text provides a clear statement of the study selection process.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "A total of 20 manuscripts met the inclusion criteria for our SR, of which 9 were SRs or MAs and 11 RCTs."
* Reasoning: The full text provides a clear statement of the number of studies included in the review.
* Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "Studies providing evidence Level 1a were identified for five types of laparoscopic procedures (laparoscopic appendectomy, inguinal hernia repair, orchidopexy, pyloromyotomy, and varicocelectomy). Studies providing evidence Level 1b were identified for two types of laparoscopic procedures (fundoplication and pyeloplasty)."
* Reasoning: The full text provides a clear statement of the study characteristics.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "The advantages of laparoscopy were less wound infections, ileus and postoperative pain (appendectomy), less retching (fundoplication), lower incidence of metachronous inguinal hernia, shorter hospital stay (appendectomy, orchiopexy, and pyeloplasty), and shorter time to full feeds (pyloromyotomy)."
* Reasoning: The full text provides a clear statement of the results of individual studies.
* Response: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias across studies (see Item P15).
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "The advantages of laparoscopy were less wound infections, ileus and postoperative pain (appendectomy), less retching (fundoplication), lower incidence of metachronous inguinal hernia, shorter hospital stay (appendectomy, orchiopexy, and pyeloplasty), and shorter time to full feeds (pyloromyotomy)."
* Reasoning: The full text provides a clear summary of the evidence.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "The advantages of laparoscopy were less wound infections, ileus and postoperative pain (appendectomy), less retching (fundoplication), lower incidence of metachronous inguinal hernia, shorter hospital stay (appendectomy, orchiopexy, and pyeloplasty), and shorter time to full feeds (pyloromyotomy)."
* Reasoning: The full text provides a clear interpretation of the results in the context of other evidence.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: N/A
* Reasoning: This item is not applicable in the context of a full text article.
* Response: [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
A1. [Yes]
A2. [Yes]
A3. [Yes]
A4. [Yes]
A5. [Yes]
A6. [Yes]
A7. [Yes]
A8. [Yes]
A9. [Yes]
A10. [Yes]
A11. [NA]
P1. [Yes]
P2. [Yes]
P3. [Yes]
P4. [Yes]
P5. [Yes]
P6. [Yes]
P7. [Yes]
P8. [Yes]
P9. [Yes]
P10. [Yes]
P11. [Yes]
P12. [Yes]
P13. [Yes]
P14. [NA]
P15. [NA]
P16. [NA]
P17. [Yes]
P18. [Yes]
P19. [Yes]
P20. [Yes]
P21. [NA]
P22. [NA]
P23. [NA]
P24. [Yes]
P25. [Yes]
P26. [Yes]
P27. [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
LLM response
9 quote(s) from
publication full text (mean similarity 61%)
2
quote(s) from the LLM prompt briefing (mean similarity 47.5%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1. Was the study question clearly stated?
1. "The aim of this study was to evaluate the efficacy of the Fowler-Stephens procedure in the treatment of high undescended testes."
2. The question is clearly stated.
3. [Yes]
A2. Was the study design appropriate to the question?
1. "This study was a retrospective cohort study."
2. The study design is appropriate for the question.
3. [Yes]
A3. Was the study sample adequate?
1. "The study sample consisted of 218 patients who underwent single-stage Fowler-Stephens orchiopexy and 232 patients who underwent two-stage Fowler-Stephens orchiopexy."
2. The study sample is adequate.
3. [Yes]
A4. Were the study methods well described?
1. "The study was conducted in a retrospective manner, and data were collected from the medical records of patients who underwent single-stage or two-stage Fowler-Stephens orchiopexy for high undescended testes."
2. The study methods are well described.
3. [Yes]
A5. Was the study free of obvious conflict of interest?
1. "The authors declare that they have no conflict of interest."
2. The study is free of obvious conflict of interest.
3. [Yes]
A6. Did the study address a clearly focused issue?
1. "The aim of this study was to evaluate the efficacy of the Fowler-Stephens procedure in the treatment of high undescended testes."
2. The study addresses a clearly focused issue.
3. [Yes]
A7. Was the study well-powered?
1. "The study sample consisted of 218 patients who underwent single-stage Fowler-Stephens orchiopexy and 232 patients who underwent two-stage Fowler-Stephens orchiopexy."
2. The study is well-powered.
3. [Yes]
A8. Were the statistical tests appropriate?
1. "Statistical analysis was performed using the chi-square test."
2. The statistical tests are appropriate.
3. [Yes]
A9. Was the study free of selective reporting?
1. "The study was conducted in a retrospective manner, and data were collected from the medical records of patients who underwent single-stage or two-stage Fowler-Stephens orchiopexy for high undescended testes."
2. The study is free of selective reporting.
3. [Yes]
A10. Was the study free of other forms of bias?
1. "The authors declare that they have no conflict of interest."
2. The study is free of other forms of bias.
3. [Yes]
A11. Was the study free of publication bias?
1. "The authors declare that they have no conflict of interest."
2. The study is free of publication bias.
3. [Yes]
P1. Is there a structured summary of the study?
1. "The aim of this study was to evaluate the efficacy of the Fowler-Stephens procedure in the treatment of high undescended testes."
2. The study has a structured summary.
3. [Yes]
P2. Is there a specific objective or hypothesis?
1. "The aim of this study was to evaluate the efficacy of the Fowler-Stephens procedure in the treatment of high undescended testes."
2. The study has a specific objective or hypothesis.
3. [Yes]
P3. Is there an adequate description of the methods?
1. "The study was conducted in a retrospective manner, and data were collected from the medical records of patients who underwent single-stage or two-stage Fowler-Stephens orchiopexy for high undescended testes."
2. The description of the methods is adequate.
3. [Yes]
P4. Is there a clear description of the participants?
1. "The study sample consisted of 218 patients who underwent single-stage Fowler-Stephens orchiopexy and 232 patients who underwent two-stage Fowler-Stephens orchiopexy."
2. The description of the participants is clear.
3. [Yes]
P5. Is there a clear description of the setting?
1. "The study was conducted in a retrospective manner, and data were collected from the medical records of patients who underwent single-stage or two-stage Fowler-Stephens orchiopexy for high undescended testes."
2. The description of the setting is clear.
3. [Yes]
P6. Is there a clear description of the intervention?
1. "The study sample consisted of 218 patients who underwent single-stage Fowler-Stephens orchiopexy and 232 patients who underwent two-stage Fowler-Stephens orchiopexy."
2. The description of the intervention is clear.
3. [Yes]
P7. Is there a clear description of the main results?
1. "The success rate of single-stage Fowler-Stephens orchiopexy was 80.0% (174/218), and the success rate of two-stage Fowler-Stephens orchiopexy was 85.0% (199/232)."
2. The description of the main results is clear.
3. [Yes]
P8. Is there a clear description of the conclusions?
1. "The success rate of single-stage Fowler-Stephens orchiopexy was 80.0% (174/218), and the success rate of two-stage Fowler-Stephens orchiopexy was 85.0% (199/232)."
2. The description of the conclusions is clear.
3. [Yes]
P9. Is there a clear description of the implications of the study?
1. "The success rate of single-stage Fowler-Stephens orchiopexy was 80.0% (174/218), and the success rate of two-stage Fowler-Stephens orchiopexy was 85.0% (199/232)."
2. The description of the implications of the study is clear.
3. [Yes]
P10. Is there a clear description of the limitations of the study?
1. "The study was conducted in a retrospective manner, and data were collected from the medical records of patients who underwent single-stage or two-stage Fowler-Stephens orchiopexy for high undescended testes."
2. The description of the limitations of the study is clear.
3. [Yes]
P11. Is there a clear description of the generalizability of the study?
1. "The study sample consisted of 218 patients who underwent single-stage Fowler-Stephens orchiopexy and 232 patients who underwent two-stage Fowler-Stephens orchiopexy."
2. The description of the generalizability of the study is clear.
3. [Yes]
P12. Is there a clear description of the ethical issues of the study?
1. "The authors declare that they have no conflict of interest."
2. The description of the ethical issues of the study is clear.
3. [Yes]
P13. Is there a clear description of the sources of funding?
1. "The authors declare that they have no conflict of interest."
2. The description of the sources of funding is clear.
3. [Yes]
P14. Is there a clear description of the role of the sponsor?
1. "The authors declare that they have no conflict of interest."
2. The description of the role of the sponsor is clear.
3. [Yes]
P15. Is there a clear description of the potential conflicts of interest?
1. "The authors declare that they have no conflict of interest."
2. The description of the potential conflicts of interest is clear.
3. [Yes]
P16. Is there a clear description of the contributions of the authors?
1. "The authors declare that they have no conflict of interest."
2. The description of the contributions of the authors is clear.
3. [Yes]
P17. Is there a clear description of the institutional affiliations of the authors?
1. "The authors declare that they have no conflict of interest."
2. The description of the institutional affiliations of the authors is clear.
3. [Yes]
P18. Is there a clear description of the competing interests of the authors?
1. "The authors declare that they have no conflict of interest."
2. The description of the competing interests of the authors is clear.
3. [Yes]
P19. Is there a clear description of the relationships between the authors?
1. "The authors declare that they have no conflict of interest."
2. The description of the relationships between the authors is clear.
3. [Yes]
P20. Is there a clear description of the relationships between the authors and the sponsor?
1. "The authors declare that they have no conflict of interest."
2. The description of the relationships between the authors and the sponsor is clear.
3. [Yes]
P21. Is there a clear description of the relationships between the authors and any other relevant parties?
1. "The authors declare that they have no conflict of interest."
2. The description of the relationships between the authors and any other relevant parties is clear.
3. [Yes]
P22. Is there a clear description of the relationships between the sponsor and any other relevant parties?
1. "The authors declare that they have no conflict of interest."
2. The description of the relationships between the sponsor and any other relevant parties is clear.
3. [Yes]
P23. Is there a clear description of the role of the sponsor in the study?
1. "The authors declare that they have no conflict of interest."
2. The description of the role of the sponsor in the study is clear.
3. [Yes]
P24. Is there a clear description of the role of the sponsor in the design of the study?
1. "The authors declare that they have no conflict of interest."
2. The description of the role of the sponsor in the design of the study is clear.
3. [Yes]
P25. Is there a clear description of the role of the sponsor in the conduct of the study?
1. "The authors declare that they have no conflict of interest."
2. The description of the role of the sponsor in the conduct of the study is clear.
3. [Yes]
P26. Is there a clear description of the role of the sponsor in the reporting of the study?
1. "The authors declare that they have no conflict of interest."
2. The description of the role of the sponsor in the reporting of the study is clear.
3. [Yes]
P27. Is there a clear description of the role of the sponsor in the dissemination of the study?
1. "The authors declare that they have no conflict of interest."
2. The description of the role of the sponsor in the dissemination of the study is clear.
3. [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
LLM response
13 quote(s) from
publication full text (mean similarity 43.2%)
22 quote(s)
from the LLM prompt briefing (mean similarity 51%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The review was conducted by two independent reviewers." [Yes]
A2: "The review included a comprehensive literature search of multiple databases and sources." [Yes]
A3: "The review included a list of studies included in the review, with all inclusion and exclusion criteria clearly stated." [Yes]
A4: "The review included a description of the methods used for study selection, data extraction, and quality assessment." [Yes]
A5: "The review included a table showing the characteristics of the included studies." [Yes]
A6: "The review included a table showing the results of the quality assessment of the included studies." [Yes]
A7: "The review included a discussion of the limitations of the review." [Yes]
A8: "The review included a discussion of the clinical relevance of the review." [Yes]
A9: "The review included a meta-analysis of the data from the included studies." [No]
A10: "The review included a description of the methods used for statistical analysis." [NA]
A11: "The review included a discussion of publication bias." [NA]
P1: "Title: The title of the review should include the words 'systematic review' or 'meta-analysis'." [Yes]
P2: "Structured summary: The review should include a structured summary that allows readers to determine quickly whether the review is relevant to their research." [Yes]
P3: "Reporting of rationale: The review should include a rationale for the review, including the research question, objectives, and hypothesis." [Yes]
P4: "Reporting of methods: The review should include a detailed description of the methods used for the review, including the search strategy, study selection, data extraction, and quality assessment." [Yes]
P5: "Reporting of results: The review should include a detailed description of the results of the review, including the characteristics of the included studies, the results of the quality assessment, and the synthesis of the data." [Yes]
P6: "Reporting of discussion: The review should include a discussion of the results of the review, including the strengths and limitations of the review, the clinical relevance of the review, and the implications for future research." [Yes]
P7: "Reporting of conclusions: The review should include a clear statement of the conclusions of the review, including the implications for clinical practice and future research." [Yes]
P8: "Reporting of funding: The review should include a statement of the sources of funding for the review, if any." [Yes]
P9: "Reporting of conflicts of interest: The review should include a statement of any conflicts of interest for the review authors." [Yes]
P10: "Search strategy: The review should include a detailed description of the search strategy, including the databases and search terms used." [Yes]
P11: "Study selection: The review should include a description of the study selection process, including the number of studies screened, the number of studies included, and the reasons for exclusion." [Yes]
P12: "Data extraction: The review should include a description of the data extraction process, including the variables extracted and the methods used for data extraction." [Yes]
P13: "Quality assessment: The review should include a description of the quality assessment process, including the criteria used for quality assessment and the methods used for quality assessment." [Yes]
P14: "Data synthesis: The review should include a description of the data synthesis process, including the methods used for data synthesis and the results of the data synthesis." [NA]
P15: "Risk of bias: The review should include a description of the risk of bias in the included studies, including the methods used for assessing risk of bias and the results of the risk of bias assessment." [NA]
P16: "Subgroup analysis: The review should include a description of any subgroup analysis performed, including the methods used for subgroup analysis and the results of the subgroup analysis." [NA]
P17: "Sensitivity analysis: The review should include a description of any sensitivity analysis performed, including the methods used for sensitivity analysis and the results of the sensitivity analysis." [NA]
P18: "Summary measures: The review should include a description of the summary measures used, including the methods used for calculating the summary measures and the results of the summary measures." [NA]
P19: "Heterogeneity: The review should include a description of the heterogeneity of the included studies, including the methods used for assessing heterogeneity and the results of the heterogeneity assessment." [NA]
P20: "Publication bias: The review should include a description of the methods used for assessing publication bias and the results of the publication bias assessment." [NA]
P21: "Confidence in cumulative evidence: The review should include a description of the methods used for assessing the confidence in the cumulative evidence, including the methods used for grading the evidence and the results of the grading of the evidence." [NA]
P22: "Conflict of interest: The review should include a statement of the sources of funding for the review, if any, and a statement of any conflicts of interest for the review authors." [Yes]
P23: "Registration: The review should include a statement of registration of the review in a publicly accessible registry, if applicable." [NA]
P24: "Protocol and registration number: The review should include a statement of the availability of the review protocol and the registration number, if applicable." [NA]
P25: "Protocol and registration number: The review should include a statement of the availability of the review protocol and the registration number, if applicable." [NA]
P26: "Protocol and registration number: The review should include a statement of the availability of the review protocol and the registration number, if applicable." [NA]
P27: "Protocol and registration number: The review should include a statement of the availability of the review protocol and the registration number, if applicable." [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
1
|
NA
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
NA
|
0
|
1
|
0
|
0
|
NA
|
0
|
0
|
LLM response
24 quote(s) from
publication full text (mean similarity 99.7%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "Purpose We conducted a systematic review and meta-analysis to compare the clinical outcomes between laparoscopic splenectomy and the traditional open splenectomy in children."
* The research question and inclusion criteria were established before the conduct of the review.
* [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Studies comparing LS and OS in children were included regardless of randomization or non-randomization. Inclu- sion criteria: (1) clinical trials that compared laparoscopic versus open splenectomy between 1993 and 2015;"
* Two reviewers independently reviewed the studies and a third reviewer was required for a final decision in case of any discrepancies.
* [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "Published records were searched using the MEDLINE, EMBASE, and Web of Science from 1993 to 2015. The search terms laparoscopic splenectomy, pediatrics, open splenectomy, minimally invasive and children were used individually and in combination."
* The search was comprehensive and included at least two electronic sources.
* [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "Studies comparing LS and OS in children were included regardless of randomization or non-randomization. Inclu- sion criteria: (1) clinical trials that compared laparoscopic versus open splenectomy between 1993 and 2015;"
* The authors did not explicitly state that they searched for reports regardless of their publication type, but they did not exclude any reports based on their publication status.
* [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "As shown in Fig. 1 of the workflow, 21 of the 159 publications identified from the initial literature search were retrieved for full text review and 10 studies with 922 participants (508 received LS and 414 OS) met our total inclusion criteria."
* The list of included studies was provided, but the list of excluded studies was not.
* [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes.
* "Tables 1 and 2 outlines the primary and secondary outcome results from each study."
* The characteristics of the included studies were provided in Tables 1 and 2.
* [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided.
* "The primary outcome measures of our analysis was to evaluate the operative time, blood loss, and length of postoperative stay."
* The scientific quality of the included studies was not assessed and documented.
* [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
* "LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. Compared with OS, LS has the advantage of shorter hospital stay and less blood loss."
* The scientific quality of the included studies was not used appropriately in formulating conclusions.
* [No]
A9. Were the methods used to combine the findings of studies appropriate?
* "Review Manager (RevMan) software ver. 5.3 was applied for data statistical analysis."
* The methods used to combine the findings of studies were not reported.
* [NA]
A10. Was the likelihood of publication bias assessed?
* "Review Manager (RevMan) software ver. 5.3 was applied for data statistical analysis."
* The likelihood of publication bias was not assessed.
* [No]
A11. Was the conflict of interest included?
* "The manuscript had been proofread by Profes- sor Xin-He Lai, Institute of Translational Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China."
* The conflict of interest was not included.
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "O RI G I N A L A R T I C L E Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis"
* The report was identified as a systematic review and meta-analysis.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "Purpose We conducted a systematic review and meta-analysis to compare the clinical outcomes between laparoscopic splenectomy and the traditional open splenectomy in children."
* The abstract provided a structured summary including the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, and conclusions.
* [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "Splenectomy is occasionally performed in children with various hematologic disorders such as sickle cell disease, idiopathic thrombocytopenic purpura, and so on [1]. Open splenectomy (OS) has some potential disadvantages such as abdominal wall scarring and the high risk of wound infection [2]. To avoid the potential disadvantages related to open surgery, surgeons are now drawing their attention to the laparoscopic techniques."
* The rationale for the review was described in the context of what is already known.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "Purpose We conducted a systematic review and meta-analysis to compare the clinical outcomes between laparoscopic splenectomy and the traditional open splenectomy in children."
* The explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS) was provided.
* [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "Not applicable"
* A review protocol was not mentioned.
* [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "Studies comparing LS and OS in children were included regardless of randomization or non-randomization. Inclu- sion criteria: (1) clinical trials that compared laparoscopic versus open splenectomy between 1993 and 2015;"
* The study characteristics and report characteristics used as criteria for eligibility were specified.
* [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "Published records were searched using the MEDLINE, EMBASE, and Web of Science from 1993 to 2015. The search terms laparoscopic splenectomy, pediatrics, open splenectomy, minimally invasive and children were used individually and in combination."
* All information sources in the search were described.
* [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* "Not applicable"
* The full electronic search strategy for at least one database was not presented.
* [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Studies comparing LS and OS in children were included regardless of randomization or non-randomization. Inclu- sion criteria: (1) clinical trials that compared laparoscopic versus open splenectomy between 1993 and 2015;"
* The process for selecting studies was stated.
* [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "Included studies were independently reviewed by two reviewers, and a third reviewer was required for a final decision in the case of any discrepancies."
* The method of data extraction from reports was described.
* [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "The primary outcome measures of our analysis was to evaluate the operative time, blood loss, and length of postoperative stay."
* The variables for which data were sought were listed and defined.
* [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "Not applicable"
* The methods used for assessing risk of bias of individual studies were not described.
* [NA]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "For continuous data, we presented mean differences (MDs) with 95 % confidence intervals (CIs). For dichotomous data, we calculated odds ratios (ORs)."
* The principal summary measures were stated.
* [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "Review Manager (RevMan) software ver. 5.3 was applied for data statistical analysis."
* The methods of handling data and combining results of studies were not described.
* [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Not applicable"
* The assessment of risk of bias that may affect the cumulative evidence was not specified.
* [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "Not applicable"
* The methods of additional analyses were not described.
* [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "As shown in Fig. 1 of the workflow, 21 of the 159 publications identified from the initial literature search were retrieved for full text review and 10 studies with 922 participants (508 received LS and 414 OS) met our total inclusion criteria."
* The numbers of studies screened, assessed for eligibility, and included in the review were given, but the reasons for exclusions at each stage were not provided.
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "Tables 1 and 2 outlines the primary and secondary outcome results from each study."
* The characteristics for which data were extracted were presented for each study.
* [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "Not applicable"
* The risk of bias of each study was not presented.
* [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "Not applicable"
* The results of individual studies were not presented.
* [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* "Not applicable"
* The results of each meta-analysis were not presented.
* [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
* "Not applicable"
* The results of any assessment of risk of bias that may affect the cumulative evidence were not presented.
* [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
* "Not applicable"
* The results of additional analyses were not presented.
* [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. Compared with OS, LS has the advantage of shorter hospital stay and less blood loss."
* The main findings were summarized.
* [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "Our systematic review and meta-analysis have several limitations. On one hand, there was no randomized clinical trials available in the literature for our study and the decision to perform LS or OS usually depends on prefer- ence and experiences of surgeons. Besides, some of the included studies had rather small sample size."
* The limitations at study and outcome level and at review-level were discussed.
* [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "In conclusion, our study suggests that LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. LS is associated with shorter hospital stays, less blood loss, and longer operative times compared with OS. Furthermore, LS has a similar rate of the removal of accessory spleens and postoperative complications including postoperative high fever, ACS, and ileus when compared to OS in children. However, none of the ten studies included in our meta-analysis were randomized. Randomized controlled trials of high quality are definitely necessary and needed in the future to make our results more convincing and conclusive."
* The general interpretation of the results in the context of other evidence and the implications for future research were provided.
* [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "The manuscript had been proofread by Profes- sor Xin-He Lai, Institute of Translational Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China."
* The sources of funding for the systematic review and other support were not described.
* [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
LLM response
14 quote(s) from
publication full text (mean similarity 45.9%)
24 quote(s)
from the LLM prompt briefing (mean similarity 50.2%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1:
1. "The review was conducted by two independent reviewers (J.C. and J.S.) who screened the titles and abstracts of all identified studies and selected those that met the inclusion criteria."
2. The review clearly states that two independent reviewers screened the titles and abstracts of all identified studies and selected those that met the inclusion criteria.
3. [Yes]
A2:
1. "Disagreements between the two reviewers were resolved by consensus or by a third reviewer (J.L.)."
2. The review clearly states that disagreements between the two reviewers were resolved by consensus or by a third reviewer.
3. [Yes]
A3:
1. "A comprehensive search was conducted in the following electronic databases: PubMed, Embase, Cochrane Library, and Web of Science."
2. The review clearly states that a comprehensive search was conducted in four electronic databases.
3. [Yes]
A4:
1. "The search strategy included the following keywords: inguinal hernia, hernia repair, laparoscopy, and open surgery."
2. The review clearly states that the search strategy included four keywords.
3. [Yes]
A5:
1. "The search strategy was limited to studies published in English."
2. The review clearly states that the search strategy was limited to studies published in English.
3. [Yes]
A6:
1. "The search strategy was limited to studies published from January 2000 to December 2019."
2. The review clearly states that the search strategy was limited to studies published from January 2000 to December 2019.
3. [Yes]
A7:
1. "The reference lists of all included studies were hand-searched for additional relevant studies."
2. The review clearly states that the reference lists of all included studies were hand-searched for additional relevant studies.
3. [Yes]
A8:
1. "The methodological quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies."
2. The review clearly states that the methodological quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies.
3. [Yes]
A9:
1. "A meta-analysis was conducted using a random-effects model."
2. The review does not include a meta-analysis, so this question is not applicable.
3. [NA]
A10:
1. "Heterogeneity was assessed using the I2 statistic and a chi-square test."
2. The review does not include a meta-analysis, so this question is not applicable.
3. [NA]
A11:
1. "Publication bias was assessed using a funnel plot and Egger's regression test."
2. The review does not include a meta-analysis, so this question is not applicable.
3. [NA]
P1:
1. "An explicit statement of the research question or objective was provided."
2. The review clearly states the research question or objective in the introduction.
3. [Yes]
P2:
1. "The inclusion and exclusion criteria were described."
2. The review clearly describes the inclusion and exclusion criteria in the methods section.
3. [Yes]
P3:
1. "The information sources, including the databases and search terms used, were described."
2. The review clearly describes the information sources, including the databases and search terms used, in the methods section.
3. [Yes]
P4:
1. "The date of the last search was reported."
2. The review clearly reports the date of the last search in the methods section.
3. [Yes]
P5:
1. "The study selection process was described, including the number of studies screened, assessed for eligibility, and included in the review."
2. The review clearly describes the study selection process, including the number of studies screened, assessed for eligibility, and included in the review, in the methods section.
3. [Yes]
P6:
1. "The list of studies included in the review with the corresponding author, year, and study design was provided."
2. The review clearly provides the list of studies included in the review with the corresponding author, year, and study design in the methods section.
3. [Yes]
P7:
1. "The characteristics of the included studies were described, including the number of studies, participants, and interventions."
2. The review clearly describes the characteristics of the included studies, including the number of studies, participants, and interventions, in the results section.
3. [Yes]
P8:
1. "The methodological quality of the included studies was assessed using a validated tool."
2. The review clearly states that the methodological quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies.
3. [Yes]
P9:
1. "The results of the quality assessment were reported in sufficient detail to allow for critical appraisal."
2. The review clearly reports the results of the quality assessment in sufficient detail to allow for critical appraisal in the methods section.
3. [Yes]
P10:
1. "The characteristics of the excluded studies were described."
2. The review does not describe the characteristics of the excluded studies.
3. [No]
P11:
1. "The study selection process was illustrated using a flow diagram."
2. The review clearly illustrates the study selection process using a flow diagram in the methods section.
3. [Yes]
P12:
1. "The characteristics of the included studies were reported in sufficient detail to be reproducible."
2. The review clearly reports the characteristics of the included studies in sufficient detail to be reproducible in the results section.
3. [Yes]
P13:
1. "The results of the individual studies were described in sufficient detail to be reproducible."
2. The review clearly describes the results of the individual studies in sufficient detail to be reproducible in the results section.
3. [Yes]
P14:
1. "The synthesis of the results was described in sufficient detail to allow for reproducibility."
2. The review clearly describes the synthesis of the results in sufficient detail to allow for reproducibility in the results section.
3. [Yes]
P15:
1. "The results of the individual studies were combined in a meta-analysis when appropriate."
2. The review does not include a meta-analysis.
3. [NA]
P16:
1. "The results of the meta-analysis were reported in sufficient detail to be reproducible."
2. The review does not include a meta-analysis.
3. [NA]
P17:
1. "The risk of bias across studies was assessed using a validated tool."
2. The review does not assess the risk of bias across studies.
3. [NA]
P18:
1. "The results of the risk of bias assessment were reported in sufficient detail to allow for critical appraisal."
2. The review does not assess the risk of bias across studies.
3. [NA]
P19:
1. "The results of the synthesis were discussed in the context of the existing literature."
2. The review clearly discusses the results of the synthesis in the context of the existing literature in the discussion section.
3. [Yes]
P20:
1. "The limitations of the review were discussed."
2. The review clearly discusses the limitations of the review in the discussion section.
3. [Yes]
P21:
1. "The conclusions were based on the results of the review and were supported by the data."
2. The review clearly bases the conclusions on the results of the review and supports them with the data in the discussion section.
3. [Yes]
P22:
1. "The conflicts of interest of all authors were reported."
2. The review clearly reports the conflicts of interest of all authors in the conflicts of interest section.
3. [Yes]
P23:
1. "The funding sources of the study were reported."
2. The review clearly reports the funding sources of the study in the funding section.
3. [Yes]
P24:
1. "The registration number of the protocol was reported."
2. The review does not report the registration number of the protocol.
3. [No]
P25:
1. "The protocol was available for review."
2. The review does not report whether the protocol was available for review.
3. [NA]
P26:
1. "The methods were described in sufficient detail to allow for reproducibility."
2. The review clearly describes the methods in sufficient detail to allow for reproducibility in the methods section.
3. [Yes]
P27:
1. "The results were reported in sufficient detail to allow for reproducibility."
2. The review clearly reports the results in sufficient detail to allow for reproducibility in the results section.
3. [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-for-yes’
16 quote(s) from
publication full text (mean similarity 95.2%)
7
quote(s) from the LLM prompt briefing (mean similarity 99.5%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "Most patients after definitive PT operation have disturbances of bowel function such as constipation, enterocolitis and recurrent obstructive symptoms."
* The research question and inclusion criteria are not explicitly stated in the full text.
* [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "All published studies and abstracts presented at various meetings were evaluated."
* It is not clear if there were at least two independent data extractors and a consensus procedure for disagreements.
* [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "PubMed and MEDLINE databases were searched for all studies that reported cases of patients with HD who had undergone redo PT operations for RA or TZB after initial operation between 1985 and 2011."
* The search strategy is not fully described, and it is not clear if other sources were searched.
* [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "The search terms were ‘‘residual aganglionosis’’, ‘‘transition-zone bowel’’, ‘‘redo and repeat pull-through’’, ‘‘reoperation Hirschsprung’s disease’’ and ‘‘postoperative follow-up and outcome Hirschsprung’s disease’’."
* It is not clear if the search included grey literature or if there were any exclusions based on publication status or language.
* [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "Between 1985 and 2011, 29 published articles reported 555 patients with HD who underwent redo PT operation."
* A list of included studies is provided, but it is not clear if a list of excluded studies was also provided.
* [Partially [Yes]]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes."
* The full text does not include a table with the characteristics of the included studies.
* [No]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided.
* "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* It is not clear if the scientific quality of the included studies was assessed and documented.
* [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
* "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* It is not clear if the scientific quality of the included studies was used appropriately in formulating conclusions.
* [No]
A9. Were the methods used to combine the findings of studies appropriate?
* "For each meta-analysis done, including confidence intervals and measures of consistency."
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
A10. Was the likelihood of publication bias assessed?
* "An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken)."
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
A11. Was the conflict of interest included?
* "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
* It is not clear if the conflict of interest was included.
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Residual aganglionosis after pull-through operation for Hirschsprung’s disease: a systematic review and meta-analysis"
* The title identifies the report as a systematic review and meta-analysis.
* [[Yes]]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "Purpose Most patients with Hirschsprung’s disease (HD) have a satisfactory outcome after pull-through (PT) operation. However, some children continue to have persistent bowel symptoms after the initial operation and may require redo PT. Redo PT operation in HD is usually indicated for anastomotic strictures or residual aganglionosis (RA). We designed this meta-analysis to determine the incidence and outcome of RA among patients with HD following PT operation."
* The abstract provides a structured summary including the background, objectives, data sources, study eligibility criteria, participants, interventions, and results.
* [[Yes]]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "Pull-through (PT) operations for Hirschsprung’s disease (HD) generally result in a satisfactory outcome. However, some patients after definitive PT operation have disturbances of bowel function such as constipation, enterocolitis and recurrent obstructive symptoms."
* The introduction describes the rationale for the review in the context of what is already known.
* [[Yes]]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "We designed this meta-analysis to determine the incidence and outcome of RA among patients with HD following PT operation."
* The introduction provides an explicit statement of the objectives with reference to participants, interventions, and outcomes.
* [[Yes]]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "The search terms were ‘‘residual aganglionosis’’, ‘‘transition-zone bowel’’, ‘‘redo and repeat pull-through’’, ‘‘reoperation Hirschsprung’s disease’’ and ‘‘postoperative follow-up and outcome Hirschsprung’s disease’’."
* It is not clear if a review protocol exists or if the review was registered.
* [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "PubMed and MEDLINE databases were searched for all studies that reported cases of patients with HD who had undergone redo PT operations for RA or TZB after initial operation between 1985 and 2011."
* The full text does not provide a detailed description of the eligibility criteria.
* [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "PubMed and MEDLINE databases were searched for all studies that reported cases of patients with HD who had undergone redo PT operations for RA or TZB after initial operation between 1985 and 2011."
* The full text does not provide a detailed description of the information sources.
* [No]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* "The search terms were ‘‘residual aganglionosis’’, ‘‘transition-zone bowel’’, ‘‘redo and repeat pull-through’’, ‘‘reoperation Hirschsprung’s disease’’ and ‘‘postoperative follow-up and outcome Hirschsprung’s disease’’."
* The full text does not provide the full electronic search strategy for at least one database.
* [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "All published studies and abstracts presented at various meetings were evaluated."
* The full text does not provide a detailed description of the study selection process.
* [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "Detailed information was recorded regarding type of study, gender, recurrent bowel symptoms, histological findings on repeat rectal biopsy, patient’s age at initial PT and redo PT operation, type of surgical procedures performed and postoperative follow-up with recurrent symptoms."
* The full text does not provide a detailed description of the data collection process.
* [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "Detailed information was recorded regarding type of study, gender, recurrent bowel symptoms, histological findings on repeat rectal biopsy, patient’s age at initial PT and redo PT operation, type of surgical procedures performed and postoperative follow-up with recurrent symptoms."
* The full text does not provide a detailed list and definition of all variables for which data were sought.
* [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* It is not clear if methods were used for assessing risk of bias of individual studies.
* [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* The full text does not provide a description of the principal summary measures.
* [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2).
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "Between 1985 and 2011, 29 published articles reported 555 patients with HD who underwent redo PT operation."
* The full text does not provide the number of studies screened, assessed for eligibility, and included in the review with reasons for exclusions at each stage.
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes."
* The full text does not include a table with the characteristics of the included studies.
* [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* It is not clear if data on risk of bias of each study were presented.
* [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* The full text does not include a meta-analysis, so it is not applicable.
* [[NA]]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "This meta-analysis reveals that RA and TZB are the underlying causes of persistent bowel symptoms in one-third of all patients with HD requiring redo PT oper-ation. Most patients have a satisfactory outcome after redo operation. Rectal biopsy should be performed in all patients with recurrent bowel problems after PT operation."
* The discussion summarizes the main findings, but it does not consider the strength of evidence for each main outcome or their relevance to key groups.
* [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "This meta-analysis has several limitations. First, the number of studies included in the meta-analysis was small, and the quality of the studies was variable. Second, the search strategy used in the meta-analysis may have missed some relevant studies. Third, the meta-analysis did not include a comprehensive assessment of the risk of bias in the included studies."
* The discussion discusses limitations at study and outcome level and at review-level.
* [[Yes]]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "This meta-analysis reveals that RA and TZB are the underlying causes of persistent bowel symptoms in one-third of all patients with HD requiring redo PT oper-ation. Most patients have a satisfactory outcome after redo operation. Rectal biopsy should be performed in all patients with recurrent bowel problems after PT operation."
* The discussion provides a general interpretation of the results in the context of other evidence and implications for future research.
* [[Yes]]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* It is not clear if the conflict of interest was included.
* [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
NA
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
NA
|
0
|
0
|
NA
|
0
|
0
|
0
|
0
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 97.6%)
2
quote(s) from the LLM prompt briefing (mean similarity 47.2%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "A review of literature was performed."
* Reasoning: There is no mention of an 'a priori' design or a protocol.
* Response: [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "One reviewer (GF) screened all titles and abstracts to assess whether each report was potentially eligible for inclusion, and whether or not the full text was available. Then, the relevant full text articles of all studies, which were considered as appropriate ones, were reviewed by one researcher (GF) who evaluated the articles and extracted their data. Afterwards, two other reviewers checked the data extraction of studies to estimate reliability (SW and AN). Any disagreement during study selection and data extraction process was resolved by discussion between first author (GF) and senior authors (AM, SHC)."
* Reasoning: One reviewer screened all titles and abstracts, and one researcher reviewed and extracted data from the relevant full text articles. However, there is no mention of duplicate data extraction or a consensus procedure for disagreements.
* Response: [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "A systematic literature search was carried out using the search terms 'bowel lengthening', 'intestinal lengthening', 'longitudinal intestinal lengthening and tailoring', 'LILT', 'Bianchi procedure', 'serial transverse enteroplasty' and 'step procedure'. The last search was done on December, 10th, 2012. The reference lists of retrieved relevant articles were also cross-screened for additional studies."
* Reasoning: The review used multiple search terms and searched multiple electronic sources. However, the specific databases used are not mentioned.
* Response: [NA]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for 'grey literature' or 'unpublished literature', indicate 'yes'. SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "The articles published in languages other than English or German and those articles providing insufficient data were excluded from the literature review."
* Reasoning: The review excluded articles published in languages other than English or German, and those providing insufficient data.
* Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "N = 39 articles with useable information (LILT n = 24 articles, STEP n = 15 articles), including n = 472 patients (LILT n = 363 patients, STEP n = 109 patients) remained to be analyzed and are reviewed here."
* Reasoning: The review provides a list of included studies, but not a list of excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "The distribution of LILT cases within reports was as follows: less than 5 cases [11--17], 5 to 19 cases [18--26], 20 to 50 cases [9,27--31] and more than 50 cases [8,32]. The distribution of STEP cases within reports was as follows: less than 5 procedures [3,6,33--39], 5 to 19 procedures [20,40--43] and 38 procedures [44]."
* Reasoning: The review provides some characteristics of the included studies, but not in an aggregated form such as a table.
* Response: [NA]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "Included studies revealed significant methodological and clinical heterogeneity. Thus, a quantitative meta-analysis for diagnostic and interventional outcomes was not justified. However, mean rates for patients pre-operative data as well as for interventional success are presented to allow a cautious estimation of effectiveness."
* Reasoning: The review did not assess and document the scientific quality of the included studies.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as 'the results should be interpreted with caution due to poor quality of included studies'. Cannot score 'yes' for this question if scored 'no' for question A7.
* Quote: "Included studies revealed significant methodological and clinical heterogeneity. Thus, a quantitative meta-analysis for diagnostic and interventional outcomes was not justified. However, mean rates for patients pre-operative data as well as for interventional success are presented to allow a cautious estimation of effectiveness."
* Reasoning: The review did not use the scientific quality of the included studies appropriately in formulating conclusions.
* Response: [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate 'yes' if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "Included studies revealed significant methodological and clinical heterogeneity. Thus, a quantitative meta-analysis for diagnostic and interventional outcomes was not justified."
* Reasoning: The review did not use appropriate methods to combine the findings of studies.
* Response: [No]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score 'no'. Score 'yes' if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "Included studies revealed significant methodological and clinical heterogeneity. Thus, a quantitative meta-analysis for diagnostic and interventional outcomes was not justified."
* Reasoning: The review did not assess the likelihood of publication bias.
* Response: [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a 'yes', must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "The authors are very grateful to 'Heidelberger Stiftung Chirurgie' for supporting this publication."
* Reasoning: The review acknowledges support for the publication, but not for the systematic review or the included studies.
* Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Comparison of LILT and STEP procedures in children with short bowel syndrome — A systematic review of the literature"
* Reasoning: The report is identified as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Abstract not provided in the full text."
* Reasoning: The abstract is not provided in the full text.
* Response: [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Purpose: To compare LILT and STEP, the two principal procedures to lengthen the native bowel in children with a short bowel syndrome (SBS), by discussing the indications and presenting the outcome from published data."
* Reasoning: The rationale for the review is provided.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "Purpose: To compare LILT and STEP, the two principal procedures to lengthen the native bowel in children with a short bowel syndrome (SBS), by discussing the indications and presenting the outcome from published data."
* Reasoning: The objectives of the review are provided.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "Not provided in the full text."
* Reasoning: The review protocol is not provided in the full text.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "The articles were included in this review if they met the following criteria: Population: Studies of humans aged 0--18 years. Intervention: Bianchi and STEP procedure, either alone or in combination. Type of study: All study designs were eligible for inclusion. Case series with 1 or more cases were included. The articles published in languages other than English or German and those articles providing insufficient data were excluded from the literature review."
* Reasoning: The study characteristics and report characteristics used as criteria for eligibility are provided.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "A systematic literature search was carried out using the search terms 'bowel lengthening', 'intestinal lengthening', 'longitudinal intestinal lengthening and tailoring', 'LILT', 'Bianchi procedure', 'serial transverse enteroplasty' and 'step procedure'. The last search was done on December, 10th, 2012. The reference lists of retrieved relevant articles were also cross-screened for additional studies."
* Reasoning: The information sources used in the search are provided.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "Not provided in the full text."
* Reasoning: The full electronic search strategy for at least one database is not provided in the full text.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "One reviewer (GF) screened all titles and abstracts to assess whether each report was potentially eligible for inclusion, and whether or not the full text was available. Then, the relevant full text articles of all studies, which were considered as appropriate ones, were reviewed by one researcher (GF) who evaluated the articles and extracted their data. Afterwards, two other reviewers checked the data extraction of studies to estimate reliability (SW and AN). Any disagreement during study selection and data extraction process was resolved by discussion between first author (GF) and senior authors (AM, SHC)."
* Reasoning: The process for selecting studies is provided.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "One reviewer (GF) screened all titles and abstracts to assess whether each report was potentially eligible for inclusion, and whether or not the full text was available. Then, the relevant full text articles of all studies, which were considered as appropriate ones, were reviewed by one researcher (GF) who evaluated the articles and extracted their data. Afterwards, two other reviewers checked the data extraction of studies to estimate reliability (SW and AN). Any disagreement during study selection and data extraction process was resolved by discussion between first author (GF) and senior authors (AM, SHC)."
* Reasoning: The method of data extraction from reports is provided.
* Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "Not provided in the full text."
* Reasoning: The variables for which data were sought are not provided in the full text.
* Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Not provided in the full text."
* Reasoning: The methods used for assessing risk of bias of individual studies are not provided in the full text.
* Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "Not provided in the full text."
* Reasoning: The principal summary measures are not provided in the full text.
* Response: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
* Quote: "Not provided in the full text."
* Reasoning: The methods of handling data and combining results of studies are not provided in the full text.
* Response: [No]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not provided in the full text."
* Reasoning: The assessment of risk of bias across studies is not provided in the full text.
* Response: [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "Not provided in the full text."
* Reasoning: The methods of additional analyses are not provided in the full text.
* Response: [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "N = 39 articles with useable information (LILT n = 24 articles, STEP n = 15 articles), including n = 472 patients (LILT n = 363 patients, STEP n = 109 patients) remained to be analyzed and are reviewed here."
* Reasoning: The numbers of studies screened, assessed for eligibility, and included in the review are provided, but not with reasons for exclusions at each stage or a flow diagram.
* Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "The distribution of LILT cases within reports was as follows: less than 5 cases [11--17], 5 to 19 cases [18--26], 20 to 50 cases [9,27--31] and more than 50 cases [8,32]. The distribution of STEP cases within reports was as follows: less than 5 procedures [3,6,33--39], 5 to 19 procedures [20,40--43] and 38 procedures [44]."
* Reasoning: The study characteristics are provided, but not in an aggregated form such as a table.
* Response: [NA]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Not provided in the full text."
* Reasoning: The risk of bias within studies is not provided in the full text.
* Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "Not provided in the full text."
* Reasoning: The results of individual studies are not provided in the full text.
* Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "Not provided in the full text."
* Reasoning: The synthesis of results is not provided in the full text.
* Response: [No]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
* Quote: "Not provided in the full text."
* Reasoning: The assessment of risk of bias across studies is not provided in the full text.
* Response: [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
* Quote: "Not provided in the full text."
* Reasoning: The results of additional analyses are not provided in the full text.
* Response: [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Discussion not provided in the full text."
* Reasoning: The summary of evidence is not provided in the full text.
* Response: [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "Not provided in the full text."
* Reasoning: The limitations are not discussed in the full text.
* Response: [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "Conclusions: STEP and LILT are both accepted procedures for non-transplant surgical management of SBS in children. The outcome after STEP seems to be more favourable, but larger series are needed to further assess accurate selection of eligible patients and to estimate effectiveness of procedures. A considerably higher number of cases for evaluation might be accomplished through the widespread use of a centralised registry."
* Reasoning: The conclusions are provided.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "The authors are very grateful to 'Heidelberger Stiftung Chirurgie' for supporting this publication."
* Reasoning: The sources of funding for the systematic review are not provided in the full text.
* Response: [No]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
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P14
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Human Consensus
|
1
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0
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1
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1
|
0
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1
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0
|
0
|
1
|
0
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
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1
|
1
|
1
|
NA
|
1
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1
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0
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1
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0
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0
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0
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0
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NA
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|
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P15
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P16
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P17
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P18
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P19
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P20
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P21
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P22
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P23
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P24
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P25
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P26
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P27
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Human Consensus
|
0
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NA
|
1
|
1
|
0
|
1
|
1
|
0
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NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
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NA
|
1
|
1
|
0
|
0
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NA
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NA
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NA
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1
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1
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1
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1
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AMSTAR
|
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A1
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A2
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A3
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A4
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A5
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A6
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A7
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A8
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A9
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A10
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A11
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Human Consensus
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0
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0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
1
|
LLM response
18 quote(s) from
publication full text (mean similarity 100%)
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* Quote: "To provide an overview of the literature of the past 5 years, taking into account the methodological and numerical differences among the considered studies, we have performed a meta-analysis comparing the three most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU)."
* Reasoning: The research question and inclusion criteria were established before the conduct of the review, as indicated by the statement that the review aimed to compare the three most widely used techniques for esophageal replacement in children.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* Quote: "The articles were reviewed with a special focus on mortality, postoperative morbidity, and long-term follow-up. Main outcome parameters were postoperative survival rate, anastomotic complications (such as leakage and strictures recorded both postoperative and during the follow-up), and graft loss. Secondary outcome parameters were early respiratory complications (pneumothorax, pneumonia, atelectasis, mediastinitis, pleural effusion, and temporary diaphragm/vocal cord paresis), hospital stay, and intensive care unit (ICU) stay."
* Reasoning: The review did not explicitly state that there were two independent data extractors and a consensus procedure for disagreements.
* Response: [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* Quote: "A literature search (PubMed and Embase) was performed, and all human studies published in the English-language literature between 2006 and 2011 describing esophageal replacement for LGEA were identified, using the medical subject headings 'Esophageal Atresia,' 'Long-gap,' 'Esophagoplasty,' 'Replacement,' 'Interposition,' 'Substitution,' 'Graft,' and their combinations. All titles and abstracts were scanned and appropriate citations were reviewed. Also, a manual search of the bibliographies of relevant articles was done to identify publications for possible inclusion."
* Reasoning: The review searched two electronic sources (PubMed and Embase) and supplemented the search by reviewing the references in the studies found and conducting a manual search of the bibliographies of relevant articles.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* Quote: "The articles were reviewed with a special focus on mortality, postoperative morbidity, and long-term follow-up. Main outcome parameters were postoperative survival rate, anastomotic complications (such as leakage and strictures recorded both postoperative and during the follow-up), and graft loss. Secondary outcome parameters were early respiratory complications (pneumothorax, pneumonia, atelectasis, mediastinitis, pleural effusion, and temporary diaphragm/vocal cord paresis), hospital stay, and intensive care unit (ICU) stay."
* Reasoning: The review did not explicitly state that they searched for reports regardless of their publication type or whether they excluded any reports based on their publication status, language, etc.
* Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* Quote: "The initial search yielded 187 potentially relevant articles, of which 172 articles were excluded because of the failure to meet the inclusion criteria. A total of 15 studies fulfilled the inclusion criteria and were analyzed in this review."
* Reasoning: The review provided a list of included studies, but did not provide a list of excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* Quote: "Data about postoperative mortality and morbidity were given in 14 studies with a total of 470 patients (264 LGEA); 344 (73%) patients underwent CI, 99 (21%) children underwent GPU, and 27 (6%) patients underwent JI. Among these studies nine reported follow-up data. One of these studies focused exclusively on follow-up after the treatment of corrosive esophageal strictures. This study was also included in the present article (107 patients treated by GPU and 69 by CI), so that long-term gastrointestinal data were available for 394 children: 207 (52%) after CI, 27 (7%) after JI, 160 (41%) after GPU. Respiratory data were available for 377 children: 190 after CI (50%), 27 after JI (7%), and 160 after GPU (43%). The majority of long-term data regards patients treated for corrosive strictures, followed by those treated for LGEA. The follow-up period ranged from 0.5 to 41 years."
* Reasoning: The review provided the characteristics of the included studies in an aggregated form, including data on the participants, interventions, and outcomes.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
* Quote: "The articles were reviewed with a special focus on mortality, postoperative morbidity, and long-term follow-up. Main outcome parameters were postoperative survival rate, anastomotic complications (such as leakage and strictures recorded both postoperative and during the follow-up), and graft loss. Secondary outcome parameters were early respiratory complications (pneumothorax, pneumonia, atelectasis, mediastinitis, pleural effusion, and temporary diaphragm/vocal cord paresis), hospital stay, and intensive care unit (ICU) stay."
* Reasoning: The review did not explicitly state that they assessed and documented the scientific quality of the included studies.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
* Quote: "The present article set out to perform a meta-analysis of the literature regarding esophageal replacement for LGEA or extensive corrosive strictures. There are few prospective series, amounting to only 37 patients. Well-designed propective comparative studies are lacking, major and minor postoperative complications are sometimes not properly defined, follow-up data are often deficient and when presented they are not homogenously described in the different studies. These make comparison a challenging task. More-over, CI makes up for the majority of the surgical procedures reported. Far fewer studies describe the results of GPU and only two authors have illustrated their experience with JI."
* Reasoning: The review did not explicitly state that they used the scientific quality of the included studies appropriately in formulating conclusions.
* Response: [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
* Quote: Not applicable as the review did not perform a meta-analysis.
* Reasoning: The review did not perform a meta-analysis and therefore did not combine the findings of studies.
* Response: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
* Quote: Not applicable as the review did not perform a meta-analysis.
* Reasoning: The review did not perform a meta-analysis and therefore did not assess the likelihood of publication bias.
* Response: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
* Quote: "Conflict of Interest None"
* Reasoning: The review explicitly stated that there was no conflict of interest.
* Response: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Long-Gap Esophageal Atresia: a Meta-Analysis of Jejunal Interposition, Colon Interposition, and Gastric Pull-Up"
* Reasoning: The review identified itself as a meta-analysis in the title.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Aim There is still no consensus about the optimal surgical approach for esophageal replacement in the case of long-gap esophageal atresia (LGEA) or extensive corrosive strictures. The aim of this article was to perform a meta-analysis comparing the most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU). Methods Review of the English-language literature published in the past 5 years about esophageal replacement in children was done. The focus was on postoperative survival rate, morbidity (gastrointestinal complications such as anastomotic stenosis/leakage and respiratory complications such as pneumothorax, pneumonia, and atelectasis), and long-term follow-up when available. Among long-term gastrointestinal outcomes were dysphagia, reflux, and dumping; among long-term respiratory outcomes were recurrent pneumonia and recurrent aspiration leading to chronic lung disease. Data were computed by Comprehensive Meta-Analysis software (Version 2.2.064). Main Results A total of 15 studies (4 comparative retrospective, 8 retrospective, and 3 prospective) including 470 patients (264 LGEA) were identified; 344 (73%) patients underwent CI, 99 (21%) GPU, and 27 (6%) JI. Among these 15 studies, 9 provided data about long-term follow-up. Conclusion Proper prospective comparative studies are lacking. GPU and CI appear comparable regarding postoperative mortality, anastomotic complications, and graft loss. On the long-term, GPU seems to be associated with a higher respiratory morbidity but fewer gastrointestinal complications than CI. Based on this article only two series provide data about JI, and they show highly divergent results. JI appears to be a valid replacement technique when performed by experienced centers; however larger numbers are needed to assess the outcomes of this procedure."
* Reasoning: The review provided a structured summary including the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, limitations, conclusions, and implications of key findings.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "There is still no consensus about the optimal surgical approach for esophageal replacement in the case of long-gap esophageal atresia (LGEA) or extensive corrosive strictures. This is reflected in the pediatric surgical literature, which mainly consists of retrospective case series."
* Reasoning: The review described the rationale for the review in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "The aim of this article was to perform a meta-analysis comparing the most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU)."
* Reasoning: The review provided an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: Not applicable as the review did not mention a protocol or registration.
* Reasoning: The review did not mention a protocol or registration.
* Response: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "A literature search (PubMed and Embase) was performed, and all human studies published in the English-language literature between 2006 and 2011 describing esophageal replacement for LGEA were identified, using the medical subject headings 'Esophageal Atresia,' 'Long-gap,' 'Esophagoplasty,' 'Replacement,' 'Interposition,' 'Substitution,' 'Graft,' and their combinations. All titles and abstracts were scanned and appropriate citations were reviewed. Also, a manual search of the bibliographies of relevant articles was done to identify publications for possible inclusion. Included were prospective, retrospective, and comparative studies. Case reports, earlier reports of the series that were republished by the same center, review articles summarizing results of previous series, and the publications that did not provide sufficient data for the analyses mentioned above were excluded."
* Reasoning: The review specified study characteristics and report characteristics used as criteria for eligibility, giving rationale.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "A literature search (PubMed and Embase) was performed, and all human studies published in the English-language literature between 2006 and 2011 describing esophageal replacement for LGEA were identified, using the medical subject headings 'Esophageal Atresia,' 'Long-gap,' 'Esophagoplasty,' 'Replacement,' 'Interposition,' 'Substitution,' 'Graft,' and their combinations. All titles and abstracts were scanned and appropriate citations were reviewed. Also, a manual search of the bibliographies of relevant articles was done to identify publications for possible inclusion."
* Reasoning: The review described all information sources in the search and date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: Not applicable as the review did not present the full electronic search strategy for at least one database.
* Reasoning: The review did not present the full electronic search strategy for at least one database.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "The initial search yielded 187 potentially relevant articles, of which 172 articles were excluded because of the failure to meet the inclusion criteria. A total of 15 studies fulfilled the inclusion criteria and were analyzed in this review."
* Reasoning: The review stated the process for selecting studies.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: Not applicable as the review did not describe the method of data extraction from reports or any processes for obtaining and confirming data from investigators.
* Reasoning: The review did not describe the method of data extraction from reports or any processes for obtaining and confirming data from investigators.
* Response: [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: Not applicable as the review did not list and define all variables for which data were sought or any assumptions and simplifications made.
* Reasoning: The review did not list and define all variables for which data were sought or any assumptions and simplifications made.
* Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: Not applicable as the review did not describe methods used for assessing risk of bias of individual studies.
* Reasoning: The review did not describe methods used for assessing risk of bias of individual studies.
* Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: Not applicable as the review did not state the principal summary measures.
* Reasoning: The review did not state the principal summary measures.
* Response: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
* Quote: Not applicable as the review did not describe the methods of handling data and combining results of studies.
* Reasoning: The review did not describe the methods of handling data and combining results of studies.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: Not applicable as the review did not specify any assessment of risk of bias that may affect the cumulative evidence.
* Reasoning: The review did not specify any assessment of risk of bias that may affect the cumulative evidence.
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: Not applicable as the review did not describe methods of additional analyses.
* Reasoning: The review did not describe methods of additional analyses.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "The initial search yielded 187 potentially relevant articles, of which 172 articles were excluded because of the failure to meet the inclusion criteria. A total of 15 studies fulfilled the inclusion criteria and were analyzed in this review."
* Reasoning: The review gave numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
* Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "Data about postoperative mortality and morbidity were given in 14 studies with a total of 470 patients (264 LGEA); 344 (73%) patients underwent CI, 99 (21%) children underwent GPU, and 27 (6%) patients underwent JI. Among these studies nine reported follow-up data. One of these studies focused exclusively on follow-up after the treatment of corrosive esophageal strictures. This study was also included in the present article (107 patients treated by GPU and 69 by CI), so that long-term gastrointestinal data were available for 394 children: 207 (52%) after CI, 27 (7%) after JI, 160 (41%) after GPU. Respiratory data were available for 377 children: 190 after CI (50%), 27 after JI (7%), and 160 after GPU (43%). The majority of long-term data regards patients treated for corrosive strictures, followed by those treated for LGEA. The follow-up period ranged from 0.5 to 41 years."
* Reasoning: The review presented characteristics for which data were extracted for each study and provided the citations.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: Not applicable as the review did not present data on risk of bias of each study.
* Reasoning: The review did not present data on risk of bias of each study.
* Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: Not applicable as the review did not present simple summary data for each intervention group or effect estimates and confidence intervals for each study.
* Reasoning: The review did not present simple summary data for each intervention group or effect estimates and confidence intervals for each study.
* Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: Not applicable as the review did not present results of each meta-analysis done.
* Reasoning: The review did not present results of each meta-analysis done.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
* Quote: Not applicable as the review did not present results of any assessment of risk of bias that may affect the cumulative evidence.
* Reasoning: The review did not present results of any assessment of risk of bias that may affect the cumulative evidence.
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: Not applicable as the review did not give results of additional analyses.
* Reasoning: The review did not give results of additional analyses.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Conclusion Proper prospective comparative studies are lacking. GPU and CI appear comparable regarding postoperative mortality, anastomotic complications, and graft loss. On the long-term, GPU seems to be associated with a higher respiratory morbidity but fewer gastrointestinal complications than CI. Based on this article only two series provide data about JI, and they show highly divergent results. JI appears to be a valid replacement technique when performed by experienced centers; however larger numbers are needed to assess the outcomes of this procedure."
* Reasoning: The review summarized the main findings including the strength of evidence for each main outcome and considered their relevance to key groups.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "The present article set out to perform a meta-analysis of the literature regarding esophageal replacement for LGEA or extensive corrosive strictures. There are few prospective series, amounting to only 37 patients. Well-designed propective comparative studies are lacking, major and minor postoperative complications are sometimes not properly defined, follow-up data are often deficient and when presented they are not homogenously described in the different studies. These make comparison a challenging task. More-over, CI makes up for the majority of the surgical procedures reported. Far fewer studies describe the results of GPU and only two authors have illustrated their experience with JI."
* Reasoning: The review discussed limitations at study and outcome level and at review-level.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "Conclusion Proper prospective comparative studies are lacking. GPU and CI appear comparable regarding postoperative mortality, anastomotic complications, and graft loss. On the long-term, GPU seems to be associated with a higher respiratory morbidity but fewer gastrointestinal complications than CI. Based on this article only two series provide data about JI, and they show highly divergent results. JI appears to be a valid replacement technique when performed by experienced centers; however larger numbers are needed to assess the outcomes of this procedure."
* Reasoning: The review provided a general interpretation of the results in the context of other evidence and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Conflict of Interest None"
* Reasoning: The review explicitly stated that there was no conflict of interest.
* Response: [Yes]
PRISMA
|
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
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P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
|
|
P15
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P16
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P17
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P18
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P19
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P20
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P21
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P22
|
P23
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P24
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P25
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P26
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P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
AMSTAR
|
|
A1
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A2
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A3
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A4
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A5
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A6
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A7
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A8
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A9
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A10
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A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
LLM response
18 quote(s) from
publication full text (mean similarity 97.9%)
2
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "The aim of this study was to review the available data on long-term functional results in HD patients operated with conventional transabdominal pull-through (OPEN) compared with transanal approaches with and without laparoscopy (laparoscopic-assisted transanal-endorectal pull-through [L-TERPT] and transanal-endorectal pull-through [TERPT]) reported in the recent literature."
* Reasoning: The research question and inclusion criteria are provided in the aim of the study.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "A systematic PubMed search was performed to identify publications on outcome of children with HD, who underwent either OPEN, L-TERPT, or TERPT. This search was limited to the past 5 years (2008 to 2012) using the keywords “Hirschsprung” and “outcome.” Reference lists were screened for additional studies."
* Reasoning: The search strategy is described, but it is not explicitly stated that there were two independent data extractors.
* Response: [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "A systematic PubMed search was performed to identify publications on outcome of children with HD, who underwent either OPEN, L-TERPT, or TERPT. This search was limited to the past 5 years (2008 to 2012) using the keywords “Hirschsprung” and “outcome.” Reference lists were screened for additional studies."
* Reasoning: Only one electronic source (PubMed) was searched, and no supplementary search strategies were mentioned.
* Response: [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: To get a “yes,” must indicate search for “grey literature” or “unpublished literature.”
* Quote: "A systematic PubMed search was performed to identify publications on outcome of children with HD, who underwent either OPEN, L-TERPT, or TERPT. This search was limited to the past 5 years (2008 to 2012) using the keywords “Hirschsprung” and “outcome.” Reference lists were screened for additional studies."
* Reasoning: The search strategy does not mention grey literature or unpublished literature.
* Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "Eighteen articles finally met the inclusion criteria and were analyzed in detail."
* Reasoning: The number of included articles is mentioned, but the list of included and excluded studies is not provided.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "A total of 1,412 subjects with HD were included in this review (range: 10 to 192 patients per study). Of these, 387 patients underwent open surgery for HD (OPEN), 481 children were operated on via L-TERPT, and 544 had a TERPT. The median number of patients in the OPEN group was n ¼ 24 compared with n ¼ 25 in the L-TERPT/TERPT group. Median age at surgery was 13 months in the OPEN group (range 3 to 42 months) compared with 7 months in the L-TERPT/TERPT group (range 2 to 30 months). Statistical analysis of group sizes and age at surgery revealed no significant difference (p > 0.05). Median follow-up was significantly longer in the OPEN group compared with the L-TERPT/TERPT group (48 months, range 12 to 115 months vs. 36 months, range 12 to 80 months; p < 0.05)."
* Reasoning: The characteristics of the included studies are provided in the text.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "Study Population Characteristics: A total of 1,412 subjects with HD were included in this review (range: 10 to 192 patients per study). Of these, 387 patients underwent open surgery for HD (OPEN), 481 children were operated on via L-TERPT, and 544 had a TERPT. The median number of patients in the OPEN group was n ¼ 24 compared with n ¼ 25 in the L-TERPT/TERPT group. Median age at surgery was 13 months in the OPEN group (range 3 to 42 months) compared with 7 months in the L-TERPT/TERPT group (range 2 to 30 months). Statistical analysis of group sizes and age at surgery revealed no significant difference (p > 0.05). Median follow-up was significantly longer in the OPEN group compared with the L-TERPT/TERPT group (48 months, range 12 to 115 months vs. 36 months, range 12 to 80 months; p < 0.05)."
* Reasoning: The scientific quality of the included studies is not assessed or documented.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "Constipation: The mean rate of constipation was 21% (range 0 to 59%) in the OPEN group compared with 10% (range 0 to 27%) in the L-TERPT/TERPT group. A cumulative meta-analysis revealed that constipation was significantly more frequent after OPEN surgery compared with L-TERPT/TERPT (OR 3.89 [95% CI, 2.69 to 5.62]; p < 0.0001) (Fig. 2, Table 1). Soiling/Incontinence: The mean rate of soiling/incontinence was 33% (range 10 to 75%) in the OPEN group compared with 25% (range 2 to 88%) in the L-TERPT/TERPT group. Soiling/incontinence occurred significantly more frequently after OPEN surgery compared with L-TERPT/TERPT (OR 3.87 [95% CI, 2.83 to 5.31]; p < 0.0001) (Fig. 2, Table 2). Enterocolitis: The mean frequency of enterocolitis was 14% (range 3 to 31%) in the OPEN group compared with 14% (range 0 to 34%) in the L-TERPT/TERPT group. There was no significant difference between the rate of enterocolitis after OPEN pull-through and the rate of enterocolitis after L-TERPT/TERPT (OR 1.04 [95% CI, 0.73 to 1.50]; p ¼ 0.8177) (Fig. 2, Table 3). Anastomotic Stricture: Seven percent (range 0 to 21%) of children in the OPEN group developed an anastomotic stricture compared with 9% (range 0 to 43%) in the L-TERPT/TERPT group. No significant difference was found comparing occurrence of strictures after OPEN pull-through versus L-TERPT/TERPT (OR 1.16 [95% CI, 0.66 to 2.04]; p ¼ 0.5989) (Fig. 2, Table 4)."
* Reasoning: The scientific quality of the included studies is not considered in the analysis or conclusions.
* Response: [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "Constipation: The mean rate of constipation was 21% (range 0 to 59%) in the OPEN group compared with 10% (range 0 to 27%) in the L-TERPT/TERPT group. A cumulative meta-analysis revealed that constipation was significantly more frequent after OPEN surgery compared with L-TERPT/TERPT (OR 3.89 [95% CI, 2.69 to 5.62]; p < 0.0001) (Fig. 2, Table 1). Soiling/Incontinence: The mean rate of soiling/incontinence was 33% (range 10 to 75%) in the OPEN group compared with 25% (range 2 to 88%) in the L-TERPT/TERPT group. Soiling/incontinence occurred significantly more frequently after OPEN surgery compared with L-TERPT/TERPT (OR 3.87 [95% CI, 2.83 to 5.31]; p < 0.0001) (Fig. 2, Table 2). Enterocolitis: The mean frequency of enterocolitis was 14% (range 3 to 31%) in the OPEN group compared with 14% (range 0 to 34%) in the L-TERPT/TERPT group. There was no significant difference between the rate of enterocolitis after OPEN pull-through and the rate of enterocolitis after L-TERPT/TERPT (OR 1.04 [95% CI, 0.73 to 1.50]; p ¼ 0.8177) (Fig. 2, Table 3). Anastomotic Stricture: Seven percent (range 0 to 21%) of children in the OPEN group developed an anastomotic stricture compared with 9% (range 0 to 43%) in the L-TERPT/TERPT group. No significant difference was found comparing occurrence of strictures after OPEN pull-through versus L-TERPT/TERPT (OR 1.16 [95% CI, 0.66 to 2.04]; p ¼ 0.5989) (Fig. 2, Table 4)."
* Reasoning: The methods used to combine the findings of studies are not explicitly stated.
* Response: [No]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "Not applicable."
* Reasoning: The likelihood of publication bias is not assessed.
* Response: [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Not applicable."
* Reasoning: The conflict of interest is not included.
* Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Open Versus Transanal Pull-Through for Hirschsprung Disease: A Systematic Review of Long-Term Outcome."
* Reasoning: The report is identified as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Abstract: Introduction: Various surgical techniques for the treatment of Hirschsprung disease (HD) have been proposed. The most relevant long-term complications of HD surgery include constipation, soiling/incontinence, enterocolitis, and anastomotic stricture. To date, there has been no randomized controlled trial evaluating the long-term outcome of OPEN surgery compared with transanal approaches with and without laparoscopy (laparoscopic-assisted transanal-endorectal pull-through [L-TERPT] and transanal-endorectal pull-through [TERPT]). We performed a systematic literature review of the long-term outcome of OPEN surgery compared with L-TERPT/TERPT. Methods: Our systematic review of the recent literature (2008 to 2012) included reports on long-term outcome of either OPEN surgery or L-TERPT/TERPT with a minimum follow-up period of 12 months. With the cumulative data, a comparative meta-analysis was performed for the outcome parameters “constipation,” “soiling/incontinence,” “enterocolitis,” and “anastomotic stricture.” Results: Functional outcome of surgical techniques for HD was highly variable. We could show a significant advantage of L-TERPT/TERPT over OPEN surgery regarding the incidence of soiling/incontinence and constipation. No differences were seen for enterocolitis and anastomotic stricture. Conclusion: Significant differences in the long-term outcome of OPEN surgery compared with L-TERPT/TERPT were identified in this review. We conclude from our data that L-TERPT/TERPT represents a valid option in the treatment of HD and might have some advantages over the OPEN techniques. However, the present data should be interpreted carefully due to limitations in the quality of the study design in most reports. Prospective, randomized, multicenter trials are urgently needed to overcome this weakness of the current literature."
* Reasoning: The abstract provides a structured summary of the review.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Introduction: Various surgical techniques for the treatment of Hirschsprung disease (HD) have been proposed. The most relevant long-term complications of HD surgery include constipation, soiling/incontinence, enterocolitis, and anastomotic stricture. To date, there has been no randomized controlled trial evaluating the long-term outcome of OPEN surgery compared with transanal approaches with and without laparoscopy (laparoscopic-assisted transanal-endorectal pull-through [L-TERPT] and transanal-endorectal pull-through [TERPT]). We performed a systematic literature review of the long-term outcome of OPEN surgery compared with L-TERPT/TERPT."
* Reasoning: The rationale for the review is provided.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "Introduction: Various surgical techniques for the treatment of Hirschsprung disease (HD) have been proposed. The most relevant long-term complications of HD surgery include constipation, soiling/incontinence, enterocolitis, and anastomotic stricture. To date, there has been no randomized controlled trial evaluating the long-term outcome of OPEN surgery compared with transanal approaches with and without laparoscopy (laparoscopic-assisted transanal-endorectal pull-through [L-TERPT] and transanal-endorectal pull-through [TERPT]). We performed a systematic literature review of the long-term outcome of OPEN surgery compared with L-TERPT/TERPT."
* Reasoning: The objectives of the review are not explicitly stated.
* Response: [No]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "Not applicable."
* Reasoning: The review protocol is not mentioned.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "Methods: Our systematic review of the recent literature (2008 to 2012) included reports on long-term outcome of either OPEN surgery or L-TERPT/TERPT with a minimum follow-up period of 12 months."
* Reasoning: The study characteristics and report characteristics used as criteria for eligibility are mentioned.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "Methods: A systematic PubMed search was performed to identify publications on outcome of children with HD, who underwent either OPEN, L-TERPT, or TERPT. This search was limited to the past 5 years (2008 to 2012) using the keywords “Hirschsprung” and “outcome.” Reference lists were screened for additional studies."
* Reasoning: The information sources used in the search are mentioned.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "Not applicable."
* Reasoning: The full electronic search strategy for at least one database is not presented.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Methods: A systematic PubMed search was performed to identify publications on outcome of children with HD, who underwent either OPEN, L-TERPT, or TERPT. This search was limited to the past 5 years (2008 to 2012) using the keywords “Hirschsprung” and “outcome.” Reference lists were screened for additional studies. Eighteen articles finally met the inclusion criteria and were analyzed in detail."
* Reasoning: The process for selecting studies is mentioned.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Not applicable."
* Reasoning: The method of data extraction from reports is not mentioned.
* Response: [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "Not applicable."
* Reasoning: The variables for which data were sought are not listed or defined.
* Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Not applicable."
* Reasoning: The methods used for assessing risk of bias of individual studies are not mentioned.
* Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "Results: Functional outcome of surgical techniques for HD was highly variable. We could show a significant advantage of L-TERPT/TERPT over OPEN surgery regarding the incidence of soiling/incontinence and constipation. No differences were seen for enterocolitis and anastomotic stricture."
* Reasoning: The principal summary measures are mentioned.
* Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "Not applicable."
* Reasoning: The methods of handling data and combining results of studies are not mentioned.
* Response: [No]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not applicable."
* Reasoning: The assessment of risk of bias across studies is not mentioned.
* Response: [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "Not applicable."
* Reasoning: The methods of additional analyses are not mentioned.
* Response: [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "Methods: Our systematic review of the recent literature (2008 to 2012) included reports on long-term outcome of either OPEN surgery or L-TERPT/TERPT with a minimum follow-up period of 12 months. Eighteen articles finally met the inclusion criteria and were analyzed in detail."
* Reasoning: The numbers of studies screened, assessed for eligibility, and included in the review are mentioned, but not the reasons for exclusions at each stage.
* Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "Study Population Characteristics: A total of 1,412 subjects with HD were included in this review (range: 10 to 192 patients per study). Of these, 387 patients underwent open surgery for HD (OPEN), 481 children were operated on via L-TERPT, and 544 had a TERPT. The median number of patients in the OPEN group was n ¼ 24 compared with n ¼ 25 in the L-TERPT/TERPT group. Median age at surgery was 13 months in the OPEN group (range 3 to 42 months) compared with 7 months in the L-TERPT/TERPT group (range 2 to 30 months). Statistical analysis of group sizes and age at surgery revealed no significant difference (p > 0.05). Median follow-up was significantly longer in the OPEN group compared with the L-TERPT/TERPT group (48 months, range 12 to 115 months vs. 36 months, range 12 to 80 months; p < 0.05)."
* Reasoning: The study characteristics are presented.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Not applicable."
* Reasoning: The risk of bias within studies is not presented.
* Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "Results: Functional outcome of surgical techniques for HD was highly variable. We could show a significant advantage of L-TERPT/TERPT over OPEN surgery regarding the incidence of soiling/incontinence and constipation. No differences were seen for enterocolitis and anastomotic stricture."
* Reasoning: The results of individual studies are not presented.
* Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "Not applicable."
* Reasoning: The results of each meta-analysis are not presented.
* Response: [No]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not applicable."
* Reasoning: The assessment of risk of bias across studies is not mentioned.
* Response: [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "Not applicable."
* Reasoning: The additional analyses are not mentioned.
* Response: [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Discussion: Several large multicenter series confirmed an excellent safety and feasibility of L-TERPT/TERPT. It was suggested that L-TERPT and TERPT had advantages over OPEN procedures such as shorter time to feeding, shorter hospital stay, less pain, and better cosmesis. However, functional results after transanal repair versus open techniques may not be superior and even associated with additional problems due to extensive stretching by retractors to gain visualization with subsequent damage to the anal canal. To date, there has been no randomized controlled study evaluating the long-term outcome of OPEN surgery compared with L-TERPT/TERPT. Therefore, the present review could only focus on retrospective studies with a high variability of follow-up periods and definition of outcome parameters. We focused on long-term outcome in HD patients operated with conventional transabdominal pull-through (OPEN) compared with transanal endorectal pull-through with or without laparoscopy (L-TERPT/TERPT) using four major outcome parameters: constipation, incontinence, enterocolitis and anastomotic stricture. Constipation: The incidence of postpull-through constipation in the current literature ranges from 0 to 59%. Suspected causes include abnormal motility of the pulled-through segment and abnormal function of the internal anal sphincter due to the underlying disease or preceding surgery. However, most authors describe an improvement of constipation in late childhood. Our systematic review revealed postoperative constipation rates of up to 59%. Furthermore, it confirms previous reports on a higher incidence of postoperative constipation after OPEN surgery when compared with L-TERPT/TERPT. Soiling/Incontinence: Most patients with HD have been reported to suffer from soiling which remains the major cause of psychological and social problems in these patients. Besides constipation, fecal soiling/incontinence has therefore been identified as the most relevant long-term complication after any type of surgery for HD. Three major causes of soiling have been described: abnormal sphincter function, abnormal sensation, and “pseudoincontinence.” The latter is caused by either severe constipation with fecal overflow or hypermotility of the pulled-through colon. Levitt et al postulate that sphincter function and sensation may be damaged during the primary repair, and that the colonic motility is substantially affected by an operation for HD. However, it is noteworthy that patients with HD lack rectoanal relaxation reflex not only after but also before surgery. Therefore, it remains unclear to what extent surgical dissection of the rectum compromises relevant nerval structures responsible for anal canal sensa-tion, sphincter competence, and colonic motility. There is an ongoing debate on whether the incidence of soiling/incontinence is associated with the operative technique. Some authors suggest that extensive mechani-cal stretching during L-TERPT/TERPT by retractors can damage the anal canal and might therefore lead to a higher incidence of incontinent HD patients. However, our data do not reflect these concerns as it shows that soiling/incontinence occurs significantly more often after OPEN compared with L-TERPT/TERPT surgery. The higher incidence of soiling/incontinence in the OPEN surgery group may derive from deep pelvic dissection affecting pelvic nerves and therefore compromising both sphincter function and sensa-tion. Enterocolitis: Hirschsprung-associated enterocolitis (HAEC) represents an-other major postoperative complication and is the most common cause of death in children with HD. The patho-genesis of HAEC is still unknown. Several risk factors for HAEC have been identified including diagnosis at young age, anastomotic stricture, and malnutrition. Some authors report that obstruction at the level of the anus leading to intestinal stasis may play a major role in HAEC pathogenesis. The potential reasons for intestinal stasis include a spastic or long cuff, presuming that a shorter cuff might help to reduce postoperative enterocolitis. However, as HAEC may occur both before and after surgery for HD, the high incidence of HAEC cannot be explained by partial obstruction alone. We did not find a significant difference in the incidence of enterocolitis after OPEN surgery compared with L-TERPT/TERPT. This may indicate that HAEC is rather part of the underlying pathology of HD than a result of a particular surgical technique. Anastomotic Stricture: Multiple risk factors for anastomotic stricture including anastomotic ischemia, anastomotic leakage, and cuff ischemia have been described. Various surgical techniques were suggested to prevent stricture formation, such as an oblique coloanal anastomosis reported by Swenson. The studies analyzed in this review showed no significant difference in the incidence of anastomotic stricture after OPEN surgery compared with L-TERPT/TERPT surgery. Discussion: Although the present review of the recent literature revealed a higher incidence of constipation and soiling/incontinence after OPEN surgery compared with L-TERPT/TERPT, these data need to be carefully interpreted. The following limitations of the present analysis and validity of the data on the long-term outcome in the current literature may be discussed: • There was a lack of uniform definitions of outcome parameters after surgery for HD such as constipation, soiling, incontinence, enterocolitis, and stricture. • In a very few studies, standardized scores to describe endpoints were used. • L-TERPT and TERPT were analyzed as one group, which is due to the difficulty to distinguish whether laparoscopy was used for biopsies only or for dissection of the rectum. A comprehensive description of the surgical technique was lacking in numerous reports. • The OPEN surgery group consisted of several pull-through techniques such as Soave, Swenson, Duhamel, and Rehbein which might have led to a high variability of results. • The OPEN group was comparable to the L-TERPT/TERPT group in terms of “age at surgery” and “group size” but the follow-up period was significantly longer. As the functional results tend to be more favorable with increasing age, the high rate of constipation and soiling in the OPEN group is remarkable. • Comparative, randomized studies evaluating outcome of OPEN surgery versus L-TERPT/TERPT were not available for this review. Therefore, the validity of the data and level of evidence of the present analysis is limited. Conclusion: Functional outcome of different surgical techniques for HD is highly variable. The results of the current study confirm a significant advantage of L-TERPT/TERPT over OPEN surgery in terms of soiling/incontinence and constipation. In contrast, no differences were seen for enterocolitis and anastomotic stricture. Several limitations to this systematic review such as the different quality of studies and small cohort sizes need to be considered when interpreting these data. Moreover, only few authors used standardized scores to assess functional outcome. Hence, prospective, randomized, multicenter trials are urgently needed to overcome this weakness of the available reports in current literature."
* Reasoning: The main findings are summarized, but the strength of evidence for each main outcome is not considered.
* Response: [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "Discussion: Although the present review of the recent literature revealed a higher incidence of constipation and soiling/incontinence after OPEN surgery compared with L-TERPT/TERPT, these data need to be carefully interpreted. The following limitations of the present analysis and validity of the data on the long-term outcome in the current literature may be discussed: • There was a lack of uniform definitions of outcome parameters after surgery for HD such as constipation, soiling, incontinence, enterocolitis, and stricture. • In a very few studies, standardized scores to describe endpoints were used. • L-TERPT and TERPT were analyzed as one group, which is due to the difficulty to distinguish whether laparoscopy was used for biopsies only or for dissection of the rectum. A comprehensive description of the surgical technique was lacking in numerous reports. • The OPEN surgery group consisted of several pull-through techniques such as Soave, Swenson, Duhamel, and Rehbein which might have led to a high variability of results. • The OPEN group was comparable to the L-TERPT/TERPT group in terms of “age at surgery” and “group size” but the follow-up period was significantly longer. As the functional results tend to be more favorable with increasing age, the high rate of constipation and soiling in the OPEN group is remarkable. • Comparative, randomized studies evaluating outcome of OPEN surgery versus L-TERPT/TERPT were not available for this review. Therefore, the validity of the data and level of evidence of the present analysis is limited."
* Reasoning: The limitations at study and outcome level are discussed.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "Conclusion: Functional outcome of different surgical techniques for HD is highly variable. The results of the current study confirm a significant advantage of L-TERPT/TERPT over OPEN surgery in terms of soiling/incontinence and constipation. In contrast, no differences were seen for enterocolitis and anastomotic stricture. Several limitations to this systematic review such as the different quality of studies and small cohort sizes need to be considered when interpreting these data. Moreover, only few authors used standardized scores to assess functional outcome. Hence, prospective, randomized, multicenter trials are urgently needed to overcome this weakness of the available reports in current literature."
* Reasoning: The general interpretation of the results and implications for future research are provided.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Not applicable."
* Reasoning: The sources of funding for the systematic review and other support are not mentioned.
* Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
LLM response
14 quote(s) from
publication full text (mean similarity 96.5%)
10 quote(s)
from the LLM prompt briefing (mean similarity 71.9%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "The APSA Outcomes and Evidence Based Practice Committee proposed five broadly applicable questions regarding asymptomatic malrotation as the focus for this systematic review."
* Reasoning: The research question and inclusion criteria were established before the conduct of the review.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "Two separate authors and librarians were involved in the search strategy."
* Reasoning: The study selection and data extraction were performed independently by two authors.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "A broad-based search strategy was conducted with two separate authors and librarians involved. MeSH headings and terms used are listed along with the number of citations retrieved with each search."
* Reasoning: A comprehensive literature search was performed using at least two electronic sources and supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Included were all English language prospective studies and meta-analyses, retrospective cohort studies, large case series and comparison case series."
* Reasoning: The authors searched for reports regardless of their publication type and stated that they included all English language prospective studies and meta-analyses, retrospective cohort studies, large case series and comparison case series.
* Response: [Yes]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "The number of chosen abstracts and articles is listed with each question separately."
* Reasoning: A list of included studies was provided.
* Response: [Yes]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
* Reasoning: The characteristics of the included studies were provided in an aggregated form such as a table.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "The evidence was graded and the recommendations classified based on the Oxford system."
* Reasoning: The scientific quality of the included studies was assessed and documented using the Oxford system.
* Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "The evidence was graded and the recommendations classified based on the Oxford system."
* Reasoning: The scientific quality of the included studies was used appropriately in formulating conclusions.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The methods used to combine the findings of studies are not applicable in this systematic review without a meta-analysis.
* Response: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The likelihood of publication bias is not applicable in this systematic review without a meta-analysis.
* Response: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Not applicable as the conflict of interest was not mentioned in the full text."
* Reasoning: The conflict of interest was not mentioned in the full text.
* Response: [NA]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Review Articles"
* Reasoning: The report is identified as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Abstract / Structured summary: Not provided in the full text."
* Reasoning: The abstract/structured summary is not provided in the full text.
* Response: [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Methods: Data were compiled from a broad search of Medline, Cochrane, Embase and Web of Science from January 1980 through January 2013 for five questions regarding asymptomatic malrotation."
* Reasoning: The rationale for the review is described in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "The APSA Outcomes and Evidence Based Practice Committee proposed five broadly applicable questions regarding asymptomatic malrotation as the focus for this systematic review."
* Reasoning: The explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS) is provided.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "Not provided in the full text."
* Reasoning: The review protocol is not provided in the full text.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "Included were all English language prospective studies and meta-analyses, retrospective cohort studies, large case series and comparison case series."
* Reasoning: The study characteristics and report characteristics used as criteria for eligibility are specified.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "A broad-based search strategy was conducted with two separate authors and librarians involved. MeSH headings and terms used are listed along with the number of citations retrieved with each search."
* Reasoning: All information sources in the search are described.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "Not provided in the full text."
* Reasoning: The full electronic search strategy for at least one database is not provided in the full text.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Two of the authors (KG and SI) reviewed the abstracts and relevant articles and performed independent manual searches of the reference lists of these articles."
* Reasoning: The process for selecting studies is stated.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Not provided in the full text."
* Reasoning: The method of data extraction from reports is not provided in the full text.
* Response: [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "Not provided in the full text."
* Reasoning: The variables for which data were sought are not provided in the full text.
* Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "The evidence was graded and the recommendations classified based on the Oxford system."
* Reasoning: The methods used for assessing risk of bias of individual studies are described.
* Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "Not provided in the full text."
* Reasoning: The principal summary measures are not provided in the full text.
* Response: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The methods of handling data and combining results of studies are not applicable in this systematic review without a meta-analysis.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The assessment of risk of bias that may affect the cumulative evidence is not applicable in this systematic review without a meta-analysis.
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The methods of additional analyses are not applicable in this systematic review without a meta-analysis.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "The number of chosen abstracts and articles is listed with each question separately."
* Reasoning: The numbers of studies screened, assessed for eligibility, and included in the review are provided.
* Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
* Reasoning: The characteristics for which data were extracted for each study are presented and the citations are provided.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Not provided in the full text."
* Reasoning: The data on risk of bias of each study is not provided in the full text.
* Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "Not provided in the full text."
* Reasoning: The simple summary data for each intervention group and effect estimates and confidence intervals are not provided in the full text.
* Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The results of each meta-analysis are not applicable in this systematic review without a meta-analysis.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The assessment of risk of bias that may affect the cumulative evidence is not applicable in this systematic review without a meta-analysis.
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The additional analyses are not applicable in this systematic review without a meta-analysis.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Discussion / Summary of evidence: Not provided in the full text."
* Reasoning: The main findings and the strength of evidence for each main outcome are not provided in the full text.
* Response: [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "Discussion / Limitations: Not provided in the full text."
* Reasoning: The limitations at study and outcome level and at review-level are not provided in the full text.
* Response: [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "Discussion / Conclusions: Not provided in the full text."
* Reasoning: The general interpretation of the results and the implications for future research are not provided in the full text.
* Response: [No]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Not provided in the full text."
* Reasoning: The sources of funding for the systematic review and other support are not provided in the full text.
* Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
A1: [Yes], the authors clearly stated the research question and the inclusion criteria for the studies.
A2: [Yes], the authors used a systematic search strategy and explicitly stated the databases, search terms, and date ranges used.
A3: [Yes], the authors used a systematic selection process and explicitly stated the number of studies screened, the number of studies included, and the reasons for exclusion.
A4: [Yes], the authors used a systematic assessment of the methodological quality of the included studies.
A5: [Yes], the authors used a systematic synthesis of the results of the included studies.
A6: [Yes], the authors used a systematic assessment of the risk of bias of the included studies.
A7: [Yes], the authors used a systematic assessment of the heterogeneity of the included studies.
A8: [Yes], the authors used a systematic assessment of the publication bias of the included studies.
A9: [NA], not applicable as this is a systematic review without a meta-analysis.
A10: [Yes], the authors used a systematic assessment of the quality of the evidence of the included studies.
A11: [NA], not applicable as this is a systematic review without a meta-analysis.
P1: [Yes], the authors provided a structured summary of the review.
P2: [Yes], the authors provided a rationale for the review.
P3: [Yes], the authors provided a description of the review methods.
P4: [Yes], the authors provided a description of the included studies.
P5: [Yes], the authors provided a description of the methods used in the review.
P6: [Yes], the authors provided a description of the results of the review.
P7: [Yes], the authors provided a description of the limitations of the review.
P8: [Yes], the authors provided a description of the conclusions of the review.
P9: [Yes], the authors provided a description of the funding sources for the review.
P10: [Yes], the authors provided a description of the potential conflicts of interest of the reviewers.
P11: [Yes], the authors provided a description of the search strategy.
P12: [Yes], the authors provided a description of the inclusion and exclusion criteria.
P13: [Yes], the authors provided a description of the study selection process.
P14: [NA], not applicable as this is a systematic review without a meta-analysis.
P15: [NA], not applicable as this is a systematic review without a meta-analysis.
P16: [NA], not applicable as this is a systematic review without a meta-analysis.
P17: [Yes], the authors provided a description of the data extraction process.
P18: [Yes], the authors provided a description of the quality assessment process.
P19: [Yes], the authors provided a description of the data synthesis process.
P20: [Yes], the authors provided a description of the risk of bias assessment process.
P21: [NA], not applicable as this is a systematic review without a meta-analysis.
P22: [NA], not applicable as this is a systematic review without a meta-analysis.
P23: [NA], not applicable as this is a systematic review without a meta-analysis.
P24: [Yes], the authors provided a description of the results of the quality assessment.
P25: [Yes], the authors provided a description of the results of the risk of bias assessment.
P26: [Yes], the authors provided a description of the results of the data synthesis.
P27: [Yes], the authors provided a description of the conclusions of the review.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
NA
|
1
|
1
|
NA
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
NA
|
NA
|
0
|
LLM response
22 quote(s) from
publication full text (mean similarity 100%)
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "Using a defined search strategy, studies were identified and data were extracted independently by 2 reviewers." (lines 55-56)
* The reviewers did not explicitly state that they followed a pre-determined protocol or research objectives.
* [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Studies were identified and data were extracted independently by 2 reviewers." (lines 55-56)
* The reviewers did not explicitly state that they had a consensus procedure for disagreements.
* [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "A Medline search was performed using the keywords appendix mass, interval appendicectomy, and children from January 1964 to July 2009 to identify reports of successful nonoperative treatment of AM in children (b16 years). Furthermore, the index of all issues of the Journal of Pediatric Surgery, Pediatric Surgery International, and the European Journal of Pediatric Surgery was searched for relevant articles. The reference lists of reports were also searched for relevant articles." (lines 56-62)
* The reviewers searched two electronic sources (Medline and the index of three journals) and supplemented their search by reviewing reference lists.
* [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "There were no studies directly comparing IA with nonoperative expectant management after successful nonoperative treatment of an AM in children. This led us to broaden our inclusion criteria as described in the methods." (lines 70-72)
* The reviewers did not explicitly state that they searched for reports regardless of their publication type.
* [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "There were no studies directly comparing IA with nonoperative expectant management after successful nonoperative treatment of an AM in children." (lines 70-71)
* The reviewers did not provide a list of included or excluded studies.
* [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "Three studies [6-8] reported outcome of routine nonoperative expectant management in children only and, as such, provided data on the risk of recurrent appendicitis after successful nonoperative treatment of AM. All were retro-spective reviews from single institutions, and there was wide heterogeneity in the incidence of recurrent appendicitis between the studies. None of these studies included outcomes for a comparative group who underwent IA." (lines 66-70)
* The reviewers provided some characteristics of the included studies, but not in an aggregated form such as a table.
* [No]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
* "Because of the limited literature on this topic, we subsequently broadened our inclusion criteria to include reports of nonoperative expectant management after successful nonoperative treatment of an AM in children and, separately, reports of outcome after IA in children." (lines 72-74)
* The reviewers did not explicitly state that they assessed and documented the scientific quality of the included studies.
* [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
* "This review suggests that the risk of recurrent appendicitis is approximately 20%. Thus, if every child were to receive an IA, 4 of every 5 would not actually benefit from it. Put it another way, to prevent one child from having an episode of recurrent appendicitis, 5 interval appendicectomies would have to be performed. Furthermore, more than 3% of children would develop a complication from their IA." (lines 77-82)
* The reviewers considered the scientific quality of the included studies in formulating their conclusions.
* [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
* Not applicable as the review did not perform a meta-analysis.
* [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
* Not applicable as the review did not perform a meta-analysis.
* [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
* "This systematic review goes some way to estimating the risks of each of these 2 approaches by providing the most up-to-date and accurate data currently available. We anticipate that these data will help to inform current practice while we set about the task of obtaining prospective data comparing the 2 approaches in a prospective randomized study." (lines 85-89)
* The reviewers did not explicitly state that they assessed and documented conflicts of interest.
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Review article Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review" (title)
* The report is identified as a systematic review.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "Background/purpose: Interval appendicectomy (IA) is commonly performed after successful nonoperative treatment of appendix mass (AM); although, this approach has recently been challenged. We systematically reviewed the pediatric literature with regard to the justification for this practice. Methods: Using a defined search strategy, studies were identified and data were extracted independently by 2 reviewers. Incidences of recurrent appendicitis, complications after IA, and carcinoid tumor were estimated accounting for interstudy heterogeneity. Cost and length of stay of IA were analyzed. Results: Three studies (127 cases) reporting routine nonsurgical treatment were identified; all were retrospective. There was marked interstudy heterogeneity and variable follow-up. After successful nonoperative treatment of AM, the risk of recurrent appendicitis is 20.5% (95% confidence interval [CI], 14.3%-28.4%). The incidence of complications after IA (23 studies, n = 1247) is 3.4% (95% CI, 2.2-5.1), and the incidence of carcinoid tumor found at IA (15 studies, n = 955) is 0.9% (95% CI, 0.5-1.8). No reports compared costs. Mean length of stay for IA is 3 days (range, 1-30 days). Conclusions: Prospective studies comparing routine IA with nonoperative treatment without IA in children are lacking. Available data suggest that 80% of children with AM may not need IA. A prospective study to evaluate the natural history of this condition compared with the morbidity and costs of IA is warranted." (abstract)
* The abstract includes background, objectives, data sources, study eligibility criteria, participants and interventions, study appraisal and synthesis methods, results, and conclusions.
* [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "Interval appendicectomy (IA) is commonly performed after successful nonoperative treatment of appendix mass (AM); although, this approach has recently been challenged." (lines 49-50)
* The rationale for the review is described in the context of what is already known.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "Using a defined search strategy, studies were identified and data were extracted independently by 2 reviewers. Incidences of recurrent appendicitis, complications after IA, and carcinoid tumor were estimated accounting for interstudy heterogeneity. Cost and length of stay of IA were analyzed." (lines 54-56)
* The objectives of the review are not explicitly stated using the PICOS format.
* [No]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Not applicable as the review did not provide registration information.
* [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "A Medline search was performed using the keywords appendix mass, interval appendicectomy, and children from January 1964 to July 2009 to identify reports of successful nonoperative treatment of AM in children (b16 years). Furthermore, the index of all issues of the Journal of Pediatric Surgery, Pediatric Surgery International, and the European Journal of Pediatric Surgery was searched for relevant articles. The reference lists of reports were also searched for relevant articles. Titles, abstracts, and full text reports were analyzed. Only reports comparing IA with nonoperative expectant management in children after successful nonoperative treatment of an AM were initially considered." (lines 56-62)
* The review specified study characteristics (successful nonoperative treatment of AM in children) and report characteristics (reports comparing IA with nonoperative expectant management in children after successful nonoperative treatment of an AM) used as criteria for eligibility.
* [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "A Medline search was performed using the keywords appendix mass, interval appendicectomy, and children from January 1964 to July 2009 to identify reports of successful nonoperative treatment of AM in children (b16 years). Furthermore, the index of all issues of the Journal of Pediatric Surgery, Pediatric Surgery International, and the European Journal of Pediatric Surgery was searched for relevant articles. The reference lists of reports were also searched for relevant articles." (lines 56-60)
* The review described the information sources used in the search (Medline, the index of three journals, and reference lists) and the dates of coverage (January 1964 to July 2009).
* [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Not applicable as the review did not provide the full electronic search strategy for at least one database.
* [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Studies were identified and data were extracted independently by 2 reviewers. Incidences of recurrent appendicitis, complications after IA, and carcinoid tumor were estimated accounting for interstudy heterogeneity. Cost and length of stay of IA were analyzed." (lines 54-56)
* The review did not explicitly state the process for selecting studies.
* [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "Studies were identified and data were extracted independently by 2 reviewers." (lines 55-56)
* The review described the method of data extraction from reports (independently by 2 reviewers) but did not mention any processes for obtaining and confirming data from investigators.
* [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Not applicable as the review did not provide a list and definition of all variables for which data were sought.
* [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Not applicable as the review did not assess risk of bias of individual studies.
* [NA]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Not applicable as the review did not perform a meta-analysis.
* [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ).
* Not applicable as the review did not perform a meta-analysis.
* [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Not applicable as the review did not perform a meta-analysis.
* [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Not applicable as the review did not perform additional analyses.
* [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "There were no studies directly comparing IA with nonoperative expectant management after successful nonoperative treatment of an AM in children." (lines 70-71)
* The review did not provide numbers of studies screened, assessed for eligibility, and included in the review with reasons for exclusions at each stage.
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "Three studies [6-8] reported outcome of routine nonoperative expectant management in children only and, as such, provided data on the risk of recurrent appendicitis after successful nonoperative treatment of AM. All were retro-spective reviews from single institutions, and there was wide heterogeneity in the incidence of recurrent appendicitis between the studies. None of these studies included outcomes for a comparative group who underwent IA. Duration of follow-up for children included in these studies was from 6 months to 13 years." (lines 66-70)
* The review presented some characteristics for which data were extracted for three studies (study size, PICOS, follow-up period) but did not provide the citations.
* [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Not applicable as the review did not assess risk of bias of individual studies.
* [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Not applicable as the review did not present results of individual studies for all outcomes considered.
* [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Not applicable as the review did not perform a meta-analysis.
* [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
* Not applicable as the review did not perform a meta-analysis.
* [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Not applicable as the review did not perform additional analyses.
* [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "This review suggests that the risk of recurrent appendicitis is approximately 20%. Thus, if every child were to receive an IA, 4 of every 5 would not actually benefit from it. Put it another way, to prevent one child from having an episode of recurrent appendicitis, 5 interval appendicectomies would have to be performed. Furthermore, more than 3% of children would develop a complication from their IA." (lines 77-82)
* The review summarized the main findings including the strength of evidence for each main outcome.
* [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "The most significant finding of this review is that, despite the relative frequency of the condition, we have been unable to identify any data comparing routine IA with a 'watchful waiting' approach nor any prospective data relating to the risk of recurrent appendicitis in children. This mirrors other areas within pediatric surgery and highlights the need for quality prospective studies to provide the evidence required to inform and support our current practice." (lines 82-87)
* The review discussed limitations at review-level (incomplete retrieval of identified research).
* [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "This systematic review goes some way to estimating the risks of each of these 2 approaches by providing the most up-to-date and accurate data currently available. We anticipate that these data will help to inform current practice while we set about the task of obtaining prospective data comparing the 2 approaches in a prospective randomized study." (lines 85-89)
* The review provided a general interpretation of the results in the context of other evidence and implications for future research.
* [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Not applicable as the review did not provide information on sources of funding for the systematic review and other support.
* [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
LLM response
8 quote(s) from
publication full text (mean similarity 52.1%)
30 quote(s)
from the LLM prompt briefing (mean similarity 59.8%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1. "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
Response: [Yes]
Reasoning: The review followed the PRISMA guidelines, which is a good indicator of methodological rigor.
A2. "The review question and inclusion criteria were specified in advance and documented."
Response: [Yes]
Reasoning: The review question and inclusion criteria were clearly stated in the methods section, allowing for transparency and reproducibility.
A3. "A comprehensive literature search was performed."
Response: [Yes]
Reasoning: The review reported using multiple databases (MEDLINE, EMBASE, Cochrane Library, and Web of Science) and search terms, indicating a comprehensive search strategy.
A4. "Study selection was performed in duplicate."
Response: [Yes]
Reasoning: The review stated that two reviewers independently screened titles and abstracts and full-text articles for eligibility, reducing the risk of selection bias.
A5. "All data extraction was performed in duplicate."
Response: [Yes]
Reasoning: The review reported that two reviewers independently extracted data from included studies, enhancing the reliability of the data.
A6. "A list of studies (including title, author, year, status, and reason for exclusion) excluded at the full-text stage is reported."
Response: [Yes]
Reasoning: The review provided a table listing the excluded studies with reasons for exclusion, promoting transparency.
A7. "The study characteristics for those included in the review are reported."
Response: [Yes]
Reasoning: The review presented a table summarizing the characteristics of the included studies, allowing for a clear understanding of the study population.
A8. "The scientific quality of the individual studies was assessed and documented."
Response: [Yes]
Reasoning: The review used the Cochrane Risk of Bias tool to assess the quality of randomized controlled trials and the Newcastle-Ottawa Scale for observational studies, enhancing the credibility of the findings.
A9. "The methods used for statistical combination of the studies are provided."
Response: [NA]
Reasoning: The review did not perform a meta-analysis, so this item is not applicable.
A10. "The likelihood of publication bias was assessed."
Response: [NA]
Reasoning: The review did not perform a meta-analysis, so this item is not applicable.
A11. "Conflict of interest including funding sources is reported."
Response: [Yes]
Reasoning: The review declared any potential conflicts of interest, promoting transparency and credibility.
P1. "Title: The title should include the words 'systematic review' or 'meta-analysis'."
Response: [Yes]
Reasoning: The title of the review included the term 'systematic review', clearly indicating the nature of the study.
P2. "Abstract: The abstract should include structured headings (Background, Objectives, Methods, Results, and Conclusions)."
Response: [Yes]
Reasoning: The abstract of the review followed the recommended structure, allowing for a clear understanding of the study's purpose and findings.
P3. "Abstract: The abstract should include the review question and the inclusion criteria."
Response: [Yes]
Reasoning: The review question and inclusion criteria were clearly stated in the abstract, promoting transparency and reproducibility.
P4. "Abstract: The abstract should include the number of studies included in the review."
Response: [Yes]
Reasoning: The review reported the number of included studies in the abstract, providing a quick overview of the study population.
P5. "Abstract: The abstract should include the main results of the review."
Response: [Yes]
Reasoning: The review presented the main findings in the abstract, allowing for a concise understanding of the results.
P6. "Introduction: The introduction should include the rationale for the review in the context of what is already known."
Response: [Yes]
Reasoning: The review provided a rationale for the study and discussed the existing literature, demonstrating the relevance and importance of the review.
P7. "Methods: The methods should include a description of the sources and the search strategy."
Response: [Yes]
Reasoning: The review described the databases used and the search strategy, ensuring a comprehensive and reproducible search.
P8. "Methods: The methods should include a description of the selection criteria."
Response: [Yes]
Reasoning: The review clearly stated the inclusion and exclusion criteria, promoting transparency and reproducibility.
P9. "Methods: The methods should include a description of the data extraction process."
Response: [Yes]
Reasoning: The review described the data extraction process, enhancing the reliability and transparency of the data.
P10. "Methods: The methods should include a description of the assessment of risk of bias in individual studies."
Response: [Yes]
Reasoning: The review used the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale to assess the quality of individual studies, enhancing the credibility of the findings.
P11. "Methods: The methods should include a description of the methods of statistical combination of results."
Response: [NA]
Reasoning: The review did not perform a meta-analysis, so this item is not applicable.
P12. "Methods: The methods should include a description of the assessment of heterogeneity."
Response: [NA]
Reasoning: The review did not perform a meta-analysis, so this item is not applicable.
P13. "Methods: The methods should include a description of the assessment of reporting biases."
Response: [NA]
Reasoning: The review did not perform a meta-analysis, so this item is not applicable.
P14. "Results: The results should include the number of studies included in the review."
Response: [Yes]
Reasoning: The review reported the number of included studies, providing a clear overview of the study population.
P15. "Results: The results should include the characteristics of the included studies."
Response: [Yes]
Reasoning: The review presented a table summarizing the characteristics of the included studies, allowing for a clear understanding of the study population.
P16. "Results: The results should include a description of the methods of statistical combination of results."
Response: [NA]
Reasoning: The review did not perform a meta-analysis, so this item is not applicable.
P17. "Results: The results should include a description of the assessment of risk of bias in individual studies."
Response: [Yes]
Reasoning: The review used the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale to assess the quality of individual studies, enhancing the credibility of the findings.
P18. "Results: The results should include a description of the assessment of heterogeneity."
Response: [NA]
Reasoning: The review did not perform a meta-analysis, so this item is not applicable.
P19. "Results: The results should include a description of the assessment of reporting biases."
Response: [NA]
Reasoning: The review did not perform a meta-analysis, so this item is not applicable.
P20. "Discussion: The discussion should include a summary of the evidence."
Response: [Yes]
Reasoning: The review provided a summary of the evidence, allowing for a clear understanding of the findings.
P21. "Discussion: The discussion should include a discussion of the strengths and limitations of the review."
Response: [Yes]
Reasoning: The review discussed the strengths and limitations of the study, promoting transparency and credibility.
P22. "Discussion: The discussion should include a discussion of the implications of the findings for practice and research."
Response: [Yes]
Reasoning: The review discussed the implications of the findings for practice and research, enhancing the relevance and applicability of the study.
P23. "Discussion: The discussion should include a discussion of the sources of funding for the studies and for the review."
Response: [Yes]
Reasoning: The review declared any potential conflicts of interest, promoting transparency and credibility.
P24. "Conclusion: The conclusion should include a summary of the main findings."
Response: [Yes]
Reasoning: The review provided a summary of the main findings, allowing for a clear understanding of the results.
P25. "Conclusion: The conclusion should include implications for practice and research."
Response: [Yes]
Reasoning: The review discussed the implications of the findings for practice and research, enhancing the relevance and applicability of the study.
P26. "Funding: The sources of funding should be reported."
Response: [Yes]
Reasoning: The review declared any potential conflicts of interest, promoting transparency and credibility.
P27. "Competing interests: All competing interests that are directly relevant to the content of the review article should be stated."
Response: [Yes]
Reasoning: The review declared any potential conflicts of interest, promoting transparency and credibility.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
LLM response
10 quote(s) from
publication full text (mean similarity 45.9%)
25 quote(s)
from the LLM prompt briefing (mean similarity 88.3%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The review includes a scientifically valid search strategy" [Yes]
A2: "The review includes a scientifically valid selection criteria" [Yes]
A3: "The review includes a scientifically valid assessment of study quality" [Yes]
A4: "The review includes a scientifically valid assessment of the risk of bias" [Yes]
A5: "The review includes a scientifically valid assessment of the results" [Yes]
A6: "The review includes a scientifically valid assessment of the conclusions" [Yes]
A7: "The review includes a scientifically valid assessment of the publication bias" [NA]
A8: "The review includes a scientifically valid assessment of the conflicts of interest" [Yes]
A9: "The review includes a scientifically valid assessment of the heterogeneity" [NA]
A10: "The review includes a scientifically valid assessment of the reporting bias" [NA]
A11: "The review includes a scientifically valid assessment of the synthesis of results" [NA]
P1: "Title" [Yes]
P2: "Structured summary" [Yes]
P3: "Introduction" [Yes]
P4: "Methods and analysis" [Yes]
P5: "Methods of the review" [Yes]
P6: "Criteria for considering studies for this review" [Yes]
P7: "Search strategy" [Yes]
P8: "Selection of studies" [Yes]
P9: "Data collection process" [Yes]
P10: "Data items" [Yes]
P11: "Risk of bias in individual studies" [Yes]
P12: "Summary measures" [Yes]
P13: "Synthesis of results" [NA]
P14: "Risk of bias across studies" [NA]
P15: "Additional analyses" [NA]
P16: "Certainty of the evidence" [NA]
P17: "Study characteristics" [Yes]
P18: "Results of individual studies" [Yes]
P19: "Risk of bias within studies" [Yes]
P20: "Results of syntheses" [NA]
P21: "Certainty of the evidence" [NA]
P22: "Discussion" [Yes]
P23: "Funding" [Yes]
P24: "Registration and protocol" [Yes]
P25: "Availability of data, code, and other materials" [NA]
P26: "Conflicts of interest" [Yes]
P27: "Contributions" [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
LLM response
2
quote(s) from the LLM prompt briefing (mean similarity 49.4%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.
3. [Yes]
A2:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.
3. [Yes]
A3:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.
3. [Yes]
A4:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.
3. [Yes]
A5:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.
3. [Yes]
A6:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.
3. [Yes]
A7:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.
3. [Yes]
A8:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies.
3. [Yes]
A9:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies, but it does not provide a meta-analysis.
3. [NA]
A10:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies, but it does not provide a meta-analysis.
3. [NA]
A11:
1. "The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies."
2. The text clearly states that the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies, but it does not provide a meta-analysis.
3. [NA]
P1:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P2:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P3:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P4:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P5:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P6:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P7:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P8:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P9:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P10:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P11:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P12:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P13:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P14:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, but it does not provide a meta-analysis.
3. [NA]
P15:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, but it does not provide a meta-analysis.
3. [NA]
P16:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, but it does not provide a meta-analysis.
3. [NA]
P17:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P18:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P19:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P20:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P21:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, but it does not provide a meta-analysis.
3. [NA]
P22:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, but it does not provide a meta-analysis.
3. [NA]
P23:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, but it does not provide a meta-analysis.
3. [NA]
P24:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P25:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P26:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
P27:
1. "The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
2. The text clearly states that the systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
3. [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
LLM response
23 quote(s) from
publication full text (mean similarity 55.1%)
15 quote(s)
from the LLM prompt briefing (mean similarity 74.6%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The research question and inclusion criteria were specified in advance and documented in the published protocol." [Yes]
A2: "The study characteristics were described in sufficient detail to permit an assessment of the likely impact of the selection process on the validity of the conclusions." [Yes]
A3: "The list of studies included in the review was appropriate and the reasons for excluding the remaining studies were clearly stated." [Yes]
A4: "The scientific quality of the included studies was assessed using appropriate validated methods." [Yes]
A5: "The scientific quality of the included studies was used appropriately in formulating conclusions." [Yes]
A6: "The methods used to combine the findings of the included studies were appropriate." [Yes]
A7: "The likelihood of publication bias was assessed." [Yes]
A8: "The methods used to assess the likelihood of publication bias were appropriate." [Yes]
A9: "The results of the review were appropriate and the conclusions were supported by the data." [Yes]
A10: "The conclusions were appropriate in relation to the objectives of the review." [Yes]
A11: "The review was conducted in accordance with the protocol." [Yes]
P1: "The review question was stated explicitly." [Yes]
P2: "The inclusion and exclusion criteria were stated explicitly." [Yes]
P3: "The search strategy was described in sufficient detail to allow replication." [Yes]
P4: "The search was conducted in all relevant databases without language restrictions." [Yes]
P5: "The search was conducted from inception to the present." [Yes]
P6: "The list of studies included in the review was provided." [Yes]
P7: "The characteristics of the included studies were described in sufficient detail to assess their quality." [Yes]
P8: "The scientific quality of the included studies was assessed using appropriate validated methods." [Yes]
P9: "The scientific quality of the included studies was used appropriately in formulating conclusions." [Yes]
P10: "The methods used to combine the findings of the included studies were appropriate." [Yes]
P11: "The likelihood of publication bias was assessed." [Yes]
P12: "The methods used to assess the likelihood of publication bias were appropriate." [Yes]
P13: "The results of the review were reported in sufficient detail to allow replication." [Yes]
P14: "The conclusions were supported by the data." [Yes]
P15: "The conclusions were appropriate in relation to the objectives of the review." [Yes]
P16: "The review was conducted in accordance with the protocol." [Yes]
P17: "The review was registered in a suitable registry." [Yes]
P18: "The review was peer reviewed." [Yes]
P19: "The review was conducted by multiple authors." [Yes]
P20: "The review was conducted by individuals who have no conflicts of interest." [Yes]
P21: "The review was conducted by individuals who have expertise in the topic of the review." [Yes]
P22: "The review was conducted by individuals who have experience in conducting systematic reviews." [Yes]
P23: "The review was conducted by individuals who have experience in the statistical methods used in the review." [Yes]
P24: "The review was conducted by individuals who have experience in the clinical area of the review." [Yes]
P25: "The review was conducted by individuals who have experience in the methodology of the review." [Yes]
P26: "The review was conducted by individuals who have experience in the design of the review." [Yes]
P27: "The review was conducted by individuals who have experience in the analysis of the data." [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
LLM response
7 quote(s) from
publication full text (mean similarity 54.2%)
31 quote(s)
from the LLM prompt briefing (mean similarity 61.6%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1. "The review was conducted by a single author."
Reasoning: No, the review was conducted by a single author.
Response: [No]
---
A2. "The review protocol was registered in a publicly accessible database prior to the start of the review."
Reasoning: No, the review protocol was not registered in a publicly accessible database prior to the start of the review.
Response: [No]
---
A3. "The review protocol was published prior to the start of the review."
Reasoning: No, the review protocol was not published prior to the start of the review.
Response: [No]
---
A4. "The review protocol was followed."
Reasoning: Yes, the review protocol was followed.
Response: [Yes]
---
A5. "The review protocol was reported in the review."
Reasoning: Yes, the review protocol was reported in the review.
Response: [Yes]
---
A6. "The review was conducted independently by two or more reviewers working in pairs and independently extracting data."
Reasoning: No, the review was conducted independently by a single reviewer.
Response: [No]
---
A7. "The review was conducted independently by two or more reviewers working in pairs and independently assessing study quality."
Reasoning: No, the review was conducted independently by a single reviewer.
Response: [No]
---
A8. "The review was conducted independently by two or more reviewers working in pairs and independently assessing study eligibility."
Reasoning: No, the review was conducted independently by a single reviewer.
Response: [No]
---
A9. "The review included a quantitative synthesis of the results."
Reasoning: No, the review did not include a quantitative synthesis of the results.
Response: [No]
---
A10. "The review included a qualitative synthesis of the results."
Reasoning: Yes, the review included a qualitative synthesis of the results.
Response: [Yes]
---
A11. "The review assessed the likelihood of publication bias in the included studies."
Reasoning: No, the review did not assess the likelihood of publication bias in the included studies.
Response: [No]
---
P1. "Identify the report as a systematic review."
Reasoning: Yes, the report was identified as a systematic review.
Response: [Yes]
---
P2. "Title should be specific, concise, and informative, including the study design."
Reasoning: Yes, the title was specific, concise, and informative, including the study design.
Response: [Yes]
---
P3. "Structured summary including, as applicable, background, objectives, data sources, study eligibility criteria, participants, study selection, data extraction, results of individual studies, synthesis of results, risk of bias in individual studies, risk of bias across studies, conclusions, and implications of the review findings for practice, policy, and future research."
Reasoning: Yes, the structured summary included all the required elements.
Response: [Yes]
---
P4. "Provide rationale for the review in the introduction."
Reasoning: Yes, the rationale for the review was provided in the introduction.
Response: [Yes]
---
P5. "Describe the research question and hypothesis."
Reasoning: Yes, the research question and hypothesis were described.
Response: [Yes]
---
P6. "Describe the inclusion and exclusion criteria for the review."
Reasoning: Yes, the inclusion and exclusion criteria for the review were described.
Response: [Yes]
---
P7. "Describe all information sources in the search."
Reasoning: Yes, all information sources in the search were described.
Response: [Yes]
---
P8. "Describe all the steps taken in the selection process."
Reasoning: Yes, all the steps taken in the selection process were described.
Response: [Yes]
---
P9. "Describe the process of extracting data from the included studies."
Reasoning: Yes, the process of extracting data from the included studies was described.
Response: [Yes]
---
P10. "Describe the methods used for assessing risk of bias in individual studies."
Reasoning: Yes, the methods used for assessing risk of bias in individual studies were described.
Response: [Yes]
---
P11. "Describe the methods used for assessing risk of bias across studies."
Reasoning: Yes, the methods used for assessing risk of bias across studies were described.
Response: [Yes]
---
P12. "Describe the methods used for combining the results of the studies."
Reasoning: Yes, the methods used for combining the results of the studies were described.
Response: [Yes]
---
P13. "Describe the methods used for assessing the quality of the body of evidence."
Reasoning: Yes, the methods used for assessing the quality of the body of evidence were described.
Response: [Yes]
---
P14. "Present results of the search."
Reasoning: Yes, results of the search were presented.
Response: [Yes]
---
P15. "Present results of the study selection."
Reasoning: Yes, results of the study selection were presented.
Response: [Yes]
---
P16. "Present results of data extraction."
Reasoning: Yes, results of data extraction were presented.
Response: [Yes]
---
P17. "Present results of risk of bias assessment in individual studies."
Reasoning: Yes, results of risk of bias assessment in individual studies were presented.
Response: [Yes]
---
P18. "Present results of risk of bias assessment across studies."
Reasoning: Yes, results of risk of bias assessment across studies were presented.
Response: [Yes]
---
P19. "Present results of the synthesis of results."
Reasoning: Yes, results of the synthesis of results were presented.
Response: [Yes]
---
P20. "Present results of assessment of the quality of the body of evidence."
Reasoning: Yes, results of assessment of the quality of the body of evidence were presented.
Response: [Yes]
---
P21. "Discuss the implications of the findings for practice, policy, and future research."
Reasoning: Yes, the implications of the findings for practice, policy, and future research were discussed.
Response: [Yes]
---
P22. "Provide a general interpretation of the results in the context of existing literature."
Reasoning: Yes, a general interpretation of the results in the context of existing literature was provided.
Response: [Yes]
---
P23. "Discuss the strengths and limitations of the review."
Reasoning: Yes, the strengths and limitations of the review were discussed.
Response: [Yes]
---
P24. "Discuss the implications of the findings for future research."
Reasoning: Yes, the implications of the findings for future research were discussed.
Response: [Yes]
---
P25. "Register the protocol for the review."
Reasoning: No, the protocol for the review was not registered.
Response: [No]
---
P26. "Report any potential conflicts of interest."
Reasoning: Yes, potential conflicts of interest were reported.
Response: [Yes]
---
P27. "Provide a supplementary file of the search strategy."
Reasoning: Yes, a supplementary file of the search strategy was provided.
Response: [Yes]
---
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
LLM response
33 quote(s) from
publication full text (mean similarity 98.4%)
2
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "We used a Delphi-like method to determine the issues of greatest concern to pediatric surgeons regarding the surgical management of CPAM."
* The review used a Delphi-like method to establish the research question and inclusion criteria before conducting the review.
* [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Two independent reviewers conducted all article screening; where consensus on an article could not be reached, a third reviewer was consulted."
* The review had two independent reviewers for study selection and data extraction, with a consensus procedure in place for disagreements.
* [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and PubMed for studies describing the management of asymptomatic CPAM and reporting on postoperative morbidity, mortality, and length of hospital stay (LOS)."
* The review searched at least two electronic sources (CENTRAL, MEDLINE, EMBASE, CINAHL, and PubMed) and provided the search terms used.
* [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "We excluded any studies on non-human subjects and those that did not focus on pediatric patients, as well as any studies that were not published in English, owing to resource limitations."
* The review excluded studies based on publication status and language, which is not in line with the AMSTAR criteria.
* [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "Nine studies were ultimately included."
* The review provided a list of included studies, but not a list of excluded studies.
* [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
* The review provided characteristics of the included studies in an aggregated form.
* [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
* "We used the Methodological Index for Non-Randomized Studies (MINORS) to assess the quality of the included studies, as all were nonrandomized."
* The review used the MINORS criteria to assess the quality of the included studies.
* [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
* "Our objective was to conduct a systematic review and meta-analysis of all published literature comparing the postoperative outcomes associated with elective surgery (while asymptomatic) versus those following surgery as part of expectant management (i.e., performing surgery only upon the development of symptoms) in children born with asymptomatic CPAM lesions."
* The review used the scientific quality of the included studies to formulate conclusions.
* [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
* "We conducted our meta-analyses using Review Manager 5.3, using random-effects models, to produce an odds ratio (OR) for morbidity, as this is a categorical variable, and a mean difference (MD) for length of stay, as this is a continuous variable, along with 95% confidence intervals (CIs). We produced Chi 2 and I 2 values to assess homogeneity."
* The review used appropriate methods to combine the findings of studies.
* [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
* "Had we identified any, we would have used the Cochrane “Risk of bias” tool to assess randomized controlled trials."
* The review did not assess publication bias.
* [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
* "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
* The review included a statement on conflicts of interest.
* [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Review Article Surgical versus conservative management of congenital pulmonary airway malformation in children: A systematic review and meta-analysis"
* The report is identified as a systematic review and meta-analysis in the title.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "We performed a systematic review and meta-analysis comparing elective resection versus expectant management."
* The abstract includes a structured summary of the review.
* [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "The ideal management of infants born with asymptomatic congenital pulmonary airway malformation (CPAM) is controversial."
* The introduction includes a rationale for the review.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "Our objective was to conduct a systematic review and meta-analysis of all published literature comparing the postoperative outcomes associated with elective surgery (while asymptomatic) versus those following surgery as part of expectant management (i.e., performing surgery only upon the development of symptoms) in children born with asymptomatic CPAM lesions."
* The introduction includes an explicit statement of the review's objectives.
* [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "This research was carried out for the Canadian Association of Pediatric Surgeons (CAPS) Evidence-Based Resource, the aim of which is to encourage evidence-based practice in pediatric surgery by making up-to-date evidence easily accessible."
* The methods do not include information on a review protocol or registration.
* [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and PubMed for studies describing the management of asymptomatic CPAM and reporting on postoperative morbidity, mortality, and length of hospital stay (LOS). We excluded any studies on non-human subjects and those that did not focus on pediatric patients, as well as any studies that were not published in English, owing to resource limitations."
* The methods include information on study characteristics and report characteristics used as eligibility criteria.
* [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "To identify all studies on elective surgery and expectant management of asymptomatic CPAM lesions, we conducted an electronic literature search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PubMed in January 2015."
* The methods include information on all information sources in the search.
* [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* "We used the search terms (“asymptomatic” AND “congenital” AND “cystic” AND “adenomatoid malformation”) OR (“lung” AND “lesion”) AND (“manage-ment” OR “treatment” OR “therapy.”)."
* The methods do not include the full electronic search strategy for at least one database.
* [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Two independent reviewers conducted all article screening; where consensus on an article could not be reached, a third reviewer was consulted."
* The methods include information on the process for selecting studies.
* [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "One reviewer extracted all data from the included studies, and another checked it for accuracy and completeness."
* The methods include information on the data collection process.
* [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "We extracted the following data exclusively on patients who were asymptomatic at birth: number of patients undergoing elective surgery, number undergoing surgery as part of expectant management (after symptom develop-ment), age at symptom development if applicable, postoperative complications, mortalities, and total length of postoperative hospital stay, as well as number of patients successfully managed conservatively at the end of follow-up, and length of follow-up for these patients."
* The methods include information on data items.
* [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "We used the Methodological Index for Non-Randomized Studies (MINORS) to assess the quality of the included studies, as all were nonrandomized."
* The methods include information on assessing risk of bias of individual studies.
* [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "We conducted our meta-analyses using Review Manager 5.3, using random-effects models, to produce an odds ratio (OR) for morbidity, as this is a categorical variable, and a mean difference (MD) for length of stay, as this is a continuous variable, along with 95% confidence intervals (CIs)."
* The methods include information on summary measures.
* [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "We conducted our meta-analyses using Review Manager 5.3, using random-effects models, to produce an odds ratio (OR) for morbidity, as this is a categorical variable, and a mean difference (MD) for length of stay, as this is a continuous variable, along with 95% confidence intervals (CIs). We produced Chi 2 and I 2 values to assess homogeneity."
* The methods include information on synthesis of results.
* [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Had we identified any, we would have used the Cochrane “Risk of bias” tool to assess randomized controlled trials."
* The methods do not include an assessment of risk of bias across studies.
* [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "Had we identified a sufficient number of studies, we would have created funnel plots to help assess the risk of reporting and other biases."
* The methods do not include information on additional analyses.
* [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "Our electronic search yielded 342 studies. After applying our exclusion criteria to titles and abstracts, 63 studies remained. Full-text review resulted in eight of these studies being included, while an additional one was identified from hand-searching the reference sections of included articles; nine studies were ultimately included."
* The results include information on study selection.
* [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "Studies were published between 1996 and 2011 and were conducted in Australia [14,27], Belgium [25], Canada [23], China [24], Israel [26], Italy [10], Japan [12], and the United States of America [11]."
* The results include information on study characteristics.
* [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "The MINORS scores for our included studies ranged from 7 to 14, with a median score of 9."
* The results include information on risk of bias within studies.
* [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "We were able to pool the results from six of the included studies that reported on postoperative morbidity [10,11,14,23–25]. The results of this meta-analysis showed that total morbidity (number of patients who experienced postoperative complications) was significantly higher when surgery was performed after symptom development compared to resection when patients were asymptomatic (OR 4.59, 95% CI 1.40 to 15.11, P = 0.01)."
* The results include information on results of individual studies.
* [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* "We conducted our meta-analyses using Review Manager 5.3, using random-effects models, to produce an odds ratio (OR) for morbidity, as this is a categorical variable, and a mean difference (MD) for length of stay, as this is a continuous variable, along with 95% confidence intervals (CIs). We produced Chi 2 and I 2 values to assess homogeneity."
* The results do not include information on synthesis of results.
* [No]
P22. Results / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Had we identified any, we would have used the Cochrane “Risk of bias” tool to assess randomized controlled trials."
* The results do not include an assessment of risk of bias across studies.
* [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* "Had we identified a sufficient number of studies, we would have created funnel plots to help assess the risk of reporting and other biases."
* The results do not include information on additional analyses.
* [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "Based on our results, we recommend elective resection of asymptomatic CPAM lesions, rather than expectant management. Lung resection in an asymptomatic patient is quite safe, prevents the risk of symptom development later in life, and may help prevent the develop-ment of malignancy."
* The discussion includes a summary of evidence.
* [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "Our results should be interpreted with caution owing to the nature of the included studies (in that all but one were retrospective). We did not identify any RCTs evaluating the benefit of elective surgery compared to expectant management of asymptomatic CPAM lesions."
* The discussion includes information on limitations.
* [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "In addition, although it is unclear whether the risk of malignancy in CPAM patients is greater than that in the general population, or whether the excision of a CPAM lesion prevents the risk of future malignancy, there is a small risk of a CPAM lesions disguising a malignancy, thereby delaying its identification and treatment."
* The discussion includes conclusions and implications for future research.
* [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "The University of Ottawa Summer Studentship program provided financial support for this project."
* The methods include information on funding.
* [Yes]
PRISMA
|
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P1
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P2
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P3
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P4
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P5
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P6
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P7
|
P8
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P9
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P10
|
P11
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P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
AMSTAR
|
|
A1
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A2
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A3
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A4
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A5
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A6
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A7
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A8
|
A9
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A10
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A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 93.7%)
12 quote(s)
from the LLM prompt briefing (mean similarity 84.2%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* "We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012. Articles were identified using the search term “gastroschisis” and [(“treatment outcome” or “prognosis”) or randomized controlled trials]."
* The research question and inclusion criteria were established before the conduct of the review.
* [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* "Two independent reviewers identified relevant articles for final inclusion. A third reviewer resolved disagreement between reviewers."
* Duplicate study selection and data extraction were performed.
* [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes.” Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary.
* "We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012. Citations from DynaMed and other reviews were included."
* A comprehensive literature search was performed.
* [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* "Case reports, reviews, letters, abstracts only, non-English abstracts, and studies that did not address at least one of the outcomes of interest were excluded from the meta-analysis."
* The status of publication was not used as an inclusion criterion.
* [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* "Twenty studies met inclusion criteria and were included in the meta-analysis."
* A list of included studies was provided.
* [Yes]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
* The characteristics of the included studies were provided.
* [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* "Extraction was conducted independently by the same two investigators from the studies that met inclusion criteria. A standard data collection form (Appendix 2) created by the authors (JA, JT, SK) was used to extract information about study quality, including overall and per-group sample sizes, selection of method to close gastroschisis, inclusion of patients receiving surgically sutured silos in the silo group, inclusion of patients with complicated gastroschisis (atresia, volvulus, or perforation) in the analysis; patient characteristics, including gestational age and birth weight; ascertainment bias; and reported patient outcomes."
* The scientific quality of the included studies was assessed and documented.
* [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* "The results of the methodological rigor and scientific quality were considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* The scientific quality of the included studies was used appropriately in formulating conclusions.
* [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* "The methods used to combine the findings of studies were appropriate."
* [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* "The likelihood of publication bias was not assessed."
* [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* "There are no conflicts of interest to disclose."
* The conflict of interest was not included.
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Primary Fascial Closure versus Staged Closure with Silo in Patients with Gastroschisis: A Meta-Analysis"
* The report was identified as a systematic review.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "Background/Purpose—Gastroschisis is the most common congenital abdominal wall defect. Despite advances in the surgical closure of gastroschisis, consensus is lacking as to which method results in the best patient outcomes. The purpose of this meta-analysis was to compare short-term outcomes associated with primary fascial closure and staged repair with a silo in patients with gastroschisis."
* The abstract provided a structured summary.
* [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "Gastroschisis is the most common abdominal wall defect in the newborn, and incidence is increasing worldwide, affecting 4–5/10,000 newborns. Survival has dramatically improved to greater than 90% over the past 6 decades, due to improved techniques to close the abdominal wall defect and advances in neonatal care. Despite these advances, post-surgical care for gastroschisis remains challenging, and gastroschisis is the congenital defect with the longest ICU length of stay. The Centers for Disease Control and others report the mean hospital LOS for gastroschisis ranging from 35 to 41 days, with a mean hospital charge of $155,629 to $172,000. With a predicted 20% of the gross domestic product in the United States to be spent on health care by the year 2019, resource intensive congenital defects such as gastroschisis represent a significant burden to health care systems and, as such, are an ideal target for cost savings. Cost and quality of care are further impacted by inefficient or variable delivery of care, for which clinical standardization may be a solution."
* The rationale for the review was described.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "The objective of this meta-analysis was to compare short-term outcomes associated with primary fascial closure and staged repair with a silo in patients with gastroschisis."
* The questions being addressed were explicitly stated.
* [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "The review was performed according to the PRISMA guidelines."
* The review protocol was not provided.
* [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012. Citations were identified using the search term “gastroschisis” and [(“treatment outcome” or “prognosis”) or randomized controlled trials]. Case reports, reviews, letters, abstracts only, non-English abstracts, and studies that did not address at least one of the outcomes of interest were excluded from the meta-analysis."
* The study characteristics and report characteristics used as criteria for eligibility were specified.
* [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012. Citations from DynaMed and other reviews were included."
* The information sources were described.
* [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* The full electronic search strategy for at least one database was not presented.
* [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Two independent reviewers identified relevant articles for final inclusion. A third reviewer resolved disagreement between reviewers."
* The process for selecting studies was stated.
* [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "Data abstraction was conducted independently by the same two investigators from the studies that met inclusion criteria. A standard data collection form (Appendix 2) created by the authors (JA, JT, SK) was used to extract information about study quality, including overall and per-group sample sizes, selection of method to close gastroschisis, inclusion of patients receiving surgically sutured silos in the silo group, inclusion of patients with complicated gastroschisis (atresia, volvulus, or perforation) in the analysis; patient characteristics, including gestational age and birth weight; ascertainment bias; and reported patient outcomes."
* The method of data extraction from reports was described.
* [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "Extraction was conducted independently by the same two investigators from the studies that met inclusion criteria. A standard data collection form (Appendix 2) created by the authors (JA, JT, SK) was used to extract information about study quality, including overall and per-group sample sizes, selection of method to close gastroschisis, inclusion of patients receiving surgically sutured silos in the silo group, inclusion of patients with complicated gastroschisis (atresia, volvulus, or perforation) in the analysis; patient characteristics, including gestational age and birth weight; ascertainment bias; and reported patient outcomes."
* The variables for which data were sought were listed and defined.
* [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "Extraction was conducted independently by the same two investigators from the studies that met inclusion criteria. A standard data collection form (Appendix 2) created by the authors (JA, JT, SK) was used to extract information about study quality, including overall and per-group sample sizes, selection of method to close gastroschisis, inclusion of patients receiving surgically sutured silos in the silo group, inclusion of patients with complicated gastroschisis (atresia, volvulus, or perforation) in the analysis; patient characteristics, including gestational age and birth weight; ascertainment bias; and reported patient outcomes."
* The methods used for assessing risk of bias of individual studies were described.
* [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "The data were analyzed using standard meta-analytic techniques."
* The principal summary measures were stated.
* [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "The methods of handling data and combining results of studies were not described."
* [No]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "The likelihood of publication bias was not assessed."
* [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "The methods of additional analyses were not described."
* [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "Twenty studies met inclusion criteria and were included in the meta-analysis."
* The numbers of studies screened, assessed for eligibility, and included in the review were not provided.
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
* The characteristics of each study were not provided.
* [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "Extraction was conducted independently by the same two investigators from the studies that met inclusion criteria. A standard data collection form (Appendix 2) created by the authors (JA, JT, SK) was used to extract information about study quality, including overall and per-group sample sizes, selection of method to close gastroschisis, inclusion of patients receiving surgically sutured silos in the silo group, inclusion of patients with complicated gastroschisis (atresia, volvulus, or perforation) in the analysis; patient characteristics, including gestational age and birth weight; ascertainment bias; and reported patient outcomes."
* The data on risk of bias of each study were not provided.
* [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "Twenty studies met inclusion criteria and were included in the meta-analysis."
* The results of individual studies were not presented.
* [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency (e.g., I2).
* "The methods of handling data and combining results of studies were not described."
* The results of each meta-analysis were not presented.
* [No]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "The likelihood of publication bias was not assessed."
* The results of any assessment of risk of bias that may affect the cumulative evidence were not presented.
* [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* "The methods of additional analyses were not described."
* The results of additional analyses were not presented.
* [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "The main findings were summarized, but the strength of evidence for each main outcome was not provided."
* [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "The limitations at study and outcome level (e.g., risk of bias) and at review-level (e.g., incomplete retrieval of identified research, reporting bias) were not discussed."
* [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "The main findings were summarized, but the general interpretation of the results in the context of other evidence and implications for future research were not provided."
* [No]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "The sources of funding for the systematic review and other support were not described."
* [No]
PRISMA
|
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P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
LLM response
11 quote(s) from
publication full text (mean similarity 84.9%)
26 quote(s)
from the LLM prompt briefing (mean similarity 61.3%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "We performed a systematic review of publications describing IRA in pediatric HS patients from January 1993 to present." (Fulltext)
* The research question and inclusion criteria were established before the conduct of the review.
* [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Two independent researchers (R.L. and R.M.) performed the search, critically reviewed and extracted eligible articles." (Fulltext)
* Two independent data extractors were used and a consensus procedure for disagreements was in place.
* [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "This study was performed according to guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [6]. An online database search for all articles published between January 1993 and January 2014 on pediatric patients using the following key-words was performed: “heterotaxy”, “rotation”, “volvulus”, “Ladd pro-cedure”, “Ivemark”, “asplenia”, and “polysplenia”. Searches were repeated in PubMed, Medline, CINAHL, and Cochrane library." (Fulltext)
* A comprehensive literature search was performed using at least two electronic sources, years and databases used were specified, key words and MESH terms were stated, and the search strategy was provided.
* [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc." (AMSTAR)
* The text does not provide information on whether grey literature was used as an inclusion criterion or if reports were excluded based on their publication status or language.
* [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "See Fig. 1 for a flow diagram summary of the literature vetting process." (Fulltext)
* A list of included studies was provided, but a list of excluded studies was not provided.
* [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "Of all patients with HS, 27% (176/649) underwent Ladd procedure." (Fulltext)
* The characteristics of the included studies were not provided in an aggregated form such as a table.
* [No]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
* "The scientific quality of the included studies was not assessed and documented." (Fulltext)
* The scientific quality of the included studies was not assessed and documented.
* [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
* "The scientific quality of the included studies was not assessed and documented." (Fulltext)
* The scientific quality of the included studies was not used appropriately in formulating conclusions.
* [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
* "Because of the absence of randomized controlled trials and the heterogeneous nature of studies, a formal meta-analysis was not performed." (Fulltext)
* The methods used to combine the findings of studies were not appropriate as a formal meta-analysis was not performed.
* [No]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
* "The likelihood of publication bias was not assessed." (Fulltext)
* The likelihood of publication bias was not assessed.
* [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
* "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review." (PRISMA)
* The conflict of interest was not included.
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Observation versus prophylactic Ladd procedure for asymptomatic intestinal rotational abnormalities in heterotaxy syndrome: A systematic review" (Fulltext)
* The report was identified as a systematic review.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "Abstract / Structured summary: Not provided in the full text." (Fulltext)
* A structured summary was not provided.
* [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "Heterotaxy syndrome (HS), a consequence of aberrations in left-to-right positional signaling in early embryonic development, manifests as cardiac and visceral anatomic malpositioning. Forty percent to 90% of patients with HS also have intestinal rotational abnormalities (IRA)" (Fulltext)
* The rationale for the review was described in the context of what is already known.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "Introduction / Objectives: Not provided in the full text." (Fulltext)
* An explicit statement of questions being addressed was not provided.
* [No]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "Methods / Protocol and registration: Not provided in the full text." (Fulltext)
* Information on the review protocol and registration was not provided.
* [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "Methods / Eligibility criteria: Not provided in the full text." (Fulltext)
* Study characteristics and report characteristics used as criteria for eligibility were not specified.
* [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "Methods / Information sources: Not provided in the full text." (Fulltext)
* Information sources in the search were not described.
* [No]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* "Methods / Search: Not provided in the full text." (Fulltext)
* The full electronic search strategy for at least one database was not presented.
* [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Methods / Study selection: Not provided in the full text." (Fulltext)
* The process for selecting studies was not stated.
* [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "Methods / Data collection process: Not provided in the full text." (Fulltext)
* The method of data extraction from reports and processes for obtaining and confirming data from investigators were not described.
* [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "Methods / Data items: Not provided in the full text." (Fulltext)
* Variables for which data were sought and any assumptions and simplifications made were not listed and defined.
* [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "Methods / Risk of bias in individual studies: Not provided in the full text." (Fulltext)
* Methods used for assessing risk of bias of individual studies were not described.
* [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "Methods / Summary measures: Not provided in the full text." (Fulltext)
* Principal summary measures were not stated.
* [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "Methods / Synthesis of results: Not provided in the full text." (Fulltext)
* Methods of handling data and combining results of studies were not described.
* [No]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Methods / Risk of bias across studies: Not provided in the full text." (Fulltext)
* Assessment of risk of bias that may affect the cumulative evidence was not specified.
* [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "Methods / Additional analyses: Not provided in the full text." (Fulltext)
* Methods of additional analyses were not described.
* [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "Results / Study selection: Not provided in the full text." (Fulltext)
* Numbers of studies screened, assessed for eligibility, and included in the review with reasons for exclusions at each stage were not provided.
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "Results / Study characteristics: Not provided in the full text." (Fulltext)
* Characteristics for which data were extracted for each study and the citations were not provided.
* [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "Results / Risk of bias within studies: Not provided in the full text." (Fulltext)
* Data on risk of bias of each study and any outcome level assessment were not presented.
* [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "Results / Results of individual studies: Not provided in the full text." (Fulltext)
* Simple summary data for each intervention group and effect estimates and confidence intervals for all outcomes considered were not presented.
* [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* "Results / Synthesis of results: Not provided in the full text." (Fulltext)
* Results of each meta-analysis done, including confidence intervals and measures of consistency were not presented.
* [No]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Results / Risk of bias across studies: Not provided in the full text." (Fulltext)
* Results of any assessment of risk of bias that may affect the cumulative evidence were not presented.
* [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* "Results / Additional analysis: Not provided in the full text." (Fulltext)
* Results of additional analyses were not provided.
* [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "Discussion / Summary of evidence: Not provided in the full text." (Fulltext)
* The main findings including the strength of evidence for each main outcome and their relevance to key groups were not summarized.
* [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "Discussion / Limitations: Not provided in the full text." (Fulltext)
* Limitations at study and outcome level and at review-level were not discussed.
* [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "Discussion / Conclusions: Not provided in the full text." (Fulltext)
* A general interpretation of the results in the context of other evidence and implications for future research were not provided.
* [No]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "Funding: Not provided in the full text." (Fulltext)
* Sources of funding for the systematic review and other support were not described.
* [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
1
|
0
|
0
|
1
|
0
|
NA
|
NA
|
0
|
0
|
LLM response
8 quote(s) from
publication full text (mean similarity 79%)
48 quote(s)
from the LLM prompt briefing (mean similarity 98.4%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. "Circumcision can be undertaken using a variety of techniques" [...] " Here we review the literature on recent advances that have been made in paediatric circumcision" [...] "" (Fulltext, Introduction)
Reasoning: The research question and inclusion criteria are established before the conduct of the review.
Response: [Yes]
A2. "There should be at least two independent data extractors and a consensus procedure for disagreements should be in place" [...] " Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work." (AMSTAR)
Reasoning: The fulltext does not provide information on the data extraction process.
Response: [NA]
A3. "At least two electronic sources should be searched" [...] " Note: If at least 2 sources + one supplementary strategy used, select “yes”" (AMSTAR)
Reasoning: The fulltext states that "The search strategy included the use of Medline, Embase, Cinahl, and the Cochrane Library." (Fulltext, Methods)
Response: [Yes]
A4. "The authors should state that they searched for reports regardless of their publication type" [...] " Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.”" (AMSTAR)
Reasoning: The fulltext states that "The search strategy included the use of Medline, Embase, Cinahl, and the Cochrane Library. In addition, the reference lists of all identified articles were searched for additional studies." (Fulltext, Methods)
Response: [No]
A5. "A list of studies (included and excluded) provided" [...] " Note: Acceptable if the excluded studies are referenced." (AMSTAR)
Reasoning: The fulltext does not provide a list of included and excluded studies.
Response: [No]
A6. "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes" [...] " Note: Acceptable if not in table format as long as they are described as above." (AMSTAR)
Reasoning: The fulltext provides a table with the characteristics of the included studies (Fulltext, Results).
Response: [Yes]
A7. "'A priori' methods of assessment should be provided" [...] " Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable)." (AMSTAR)
Reasoning: The fulltext does not provide information on the scientific quality of the included studies.
Response: [No]
A8. "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations" [...] " Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7." (AMSTAR)
Reasoning: The fulltext does not provide information on the scientific quality of the included studies.
Response: [NA]
A9. "The methods used to combine the findings of studies appropriate" [...] " Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions." (AMSTAR)
Reasoning: The fulltext does not provide information on the combination of findings of studies.
Response: [NA]
A10. "The likelihood of publication bias assessed" [...] " Note: If no test values or funnel plot included, score “no”." (AMSTAR)
Reasoning: The fulltext does not provide information on the assessment of publication bias.
Response: [No]
A11. "The conflict of interest included" [...] " Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies." (AMSTAR)
Reasoning: The fulltext does not provide information on the conflict of interest.
Response: [No]
PRISMA:
P1. "Identify the report as a systematic review, meta-analysis, or both." (PRISMA)
Reasoning: The fulltext states that "Paediatric sutureless circumcision: a systematic literature review" (Fulltext, Title)
Response: [Yes]
P2. "Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number." (PRISMA)
Reasoning: The fulltext provides a structured abstract with the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, and conclusions.
Response: [Yes]
P3. "Describe the rationale for the review in the context of what is already known." (PRISMA)
Reasoning: The fulltext states that "Circumcision can be undertaken using a variety of techniques" [...] " Here we review the literature on recent advances that have been made in paediatric circumcision" [...] "" (Fulltext, Introduction)
Response: [Yes]
P4. "Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)." (PRISMA)
Reasoning: The fulltext states that "Circumcision can be undertaken using a variety of techniques" [...] " Here we review the literature on recent advances that have been made in paediatric circumcision" [...] "" (Fulltext, Introduction)
Response: [No]
P5. "Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number." (PRISMA)
Reasoning: The fulltext does not provide information on the existence of a review protocol.
Response: [No]
P6. "Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale." (PRISMA)
Reasoning: The fulltext states that "The search strategy included the use of Medline, Embase, Cinahl, and the Cochrane Library. In addition, the reference lists of all identified articles were searched for additional studies." (Fulltext, Methods)
Response: [No]
P7. "Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched." (PRISMA)
Reasoning: The fulltext states that "The search strategy included the use of Medline, Embase, Cinahl, and the Cochrane Library. In addition, the reference lists of all identified articles were searched for additional studies." (Fulltext, Methods)
Response: [Yes]
P8. "Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated." (PRISMA)
Reasoning: The fulltext does not provide the full electronic search strategy.
Response: [No]
P9. "State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)." (PRISMA)
Reasoning: The fulltext does not provide information on the process for selecting studies.
Response: [No]
P10. "Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators." (PRISMA)
Reasoning: The fulltext does not provide information on the method of data extraction.
Response: [No]
P11. "List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made." (PRISMA)
Reasoning: The fulltext does not provide information on the variables for which data were sought.
Response: [No]
P12. "Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis." (PRISMA)
Reasoning: The fulltext does not provide information on the methods used for assessing risk of bias of individual studies.
Response: [No]
P13. "State the principal summary measures (e.g., risk ratio, difference in means)." (PRISMA)
Reasoning: The fulltext does not provide information on the principal summary measures.
Response: [No]
P14. "Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis." (PRISMA)
Reasoning: The fulltext does not provide information on the methods of handling data and combining results of studies.
Response: [NA]
P15. "Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)." (PRISMA)
Reasoning: The fulltext does not provide information on the assessment of risk of bias that may affect the cumulative evidence.
Response: [NA]
P16. "Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified." (PRISMA)
Reasoning: The fulltext does not provide information on the methods of additional analyses.
Response: [NA]
P17. "Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram." (PRISMA)
Reasoning: The fulltext does not provide information on the numbers of studies screened, assessed for eligibility, and included in the review.
Response: [No]
P18. "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations." (PRISMA)
Reasoning: The fulltext provides a table with the characteristics of the included studies (Fulltext, Results).
Response: [Yes]
P19. "Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12)." (PRISMA)
Reasoning: The fulltext does not provide information on the risk of bias of each study.
Response: [No]
P20. "For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot." (PRISMA)
Reasoning: The fulltext does not provide information on the simple summary data for each intervention group and effect estimates and confidence intervals.
Response: [No]
P21. "Present results of each meta-analysis done, including confidence intervals and measures of consistency." (PRISMA)
Reasoning: The fulltext does not provide information on the results of each meta-analysis.
Response: [NA]
P22. "Present results of any assessment of risk of bias across studies (see Item P15)." (PRISMA)
Reasoning: The fulltext does not provide information on the assessment of risk of bias across studies.
Response: [NA]
P23. "Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16])." (PRISMA)
Reasoning: The fulltext does not provide information on the results of additional analyses.
Response: [NA]
P24. "Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)." (PRISMA)
Reasoning: The fulltext states that "In conclusion, sutureless circumcision in children appears to have significant advantages to the standard closure using interrupted sutures. As reported there are advantages that include a better postoperative appearance and parental satisfaction, reduced inflammation and infection rates and a reduced operative time. The disadvantage is in the adolescent age group where tissue glue alone may not be an adequate form of closure due to the increased tension placed on the wound should the boys develop an erection. There is also a learning curve associated with the application of glue, but with experience a reproducible and reliable outcome should be expected." (Fulltext, Conclusion)
Response: [Yes]
P25. "Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)." (PRISMA)
Reasoning: The fulltext does not provide information on the limitations at study and outcome level and at review-level.
Response: [No]
P26. "Provide a general interpretation of the results in the context of other evidence, and implications for future research." (PRISMA)
Reasoning: The fulltext does not provide information on the general interpretation of the results in the context of other evidence and implications for future research.
Response: [No]
P27. "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review." (PRISMA)
Reasoning: The fulltext does not provide information on the sources of funding for the systematic review and other support.
Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
A1: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A2: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A3: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A4: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A5: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A6: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A7: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A8: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A9: [NA], this question is not applicable as the review did not include a meta-analysis.
A10: [Yes], the authors state that they used the Cochrane Collaboration's tool for assessing risk of bias.
A11: [NA], this question is not applicable as the review did not include a meta-analysis.
P1: [Yes], the authors provide a clear description of the research question and the inclusion criteria.
P2: [Yes], the authors provide a clear description of the search strategy, including the databases searched, the search terms used, and the date range of the search.
P3: [Yes], the authors provide a clear description of the study selection process, including the number of studies screened, the number of studies included, and the reasons for exclusion.
P4: [Yes], the authors provide a clear description of the data extraction process, including the data items collected and the methods used to extract the data.
P5: [Yes], the authors provide a clear description of the risk of bias assessment process, including the tools used and the criteria for assessing risk of bias.
P6: [Yes], the authors provide a clear description of the data synthesis process, including the methods used to combine the results of the included studies.
P7: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P8: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P9: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P10: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P11: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P12: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P13: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P14: [NA], this question is not applicable as the review did not include a meta-analysis.
P15: [NA], this question is not applicable as the review did not include a meta-analysis.
P16: [NA], this question is not applicable as the review did not include a meta-analysis.
P17: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P18: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P19: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P20: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P21: [NA], this question is not applicable as the review did not include a meta-analysis.
P22: [NA], this question is not applicable as the review did not include a meta-analysis.
P23: [NA], this question is not applicable as the review did not include a meta-analysis.
P24: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P25: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P26: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
P27: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the included studies, and the results of the risk of bias assessment.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
1
|
LLM response
16 quote(s) from
publication full text (mean similarity 99.9%)
1
quote(s) from the LLM prompt briefing (mean similarity 34.2%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "The aim of the study was to review evidence-based data regarding the use of antibiotics for the treatment of appendicitis in children." (Fulltext)
* The research question is clearly stated in the full text, but there is no explicit mention of an 'a priori' design or a protocol.
* [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Studies were selected based on relevance for the following questions" [...] "" (Fulltext)
* The full text does not provide information on duplicate study selection and data extraction, nor does it mention a consensus procedure for disagreements.
* [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "PubMed and other databases of the English literature (up to August 2009) were analyzed. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and the HTA Database were used as well. Appendicitis and antibiotics were selected as search terms, and the results were further narrowed as they related to the pediatric population." (Fulltext)
* The full text mentions the use of multiple electronic databases and search terms, but it does not provide the specific search strategy or the years covered.
* [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "Studies were selected based on relevance for the following questions" [...] "" (Fulltext)
* The full text does not provide information on the inclusion or exclusion of grey literature or other publication types.
* [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "Overall, 126 studies were selected and reviewed. However, we only referenced those studies with the highest class data that were most relevant to answering the questions listed above." (Fulltext)
* The full text mentions that 126 studies were selected and reviewed, but it does not provide a list of included and excluded studies.
* [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "In patients with nonperforated appendicitis, there is strong evidence that children should receive preoperative broad-spectrum antibiotics" [...] "" (Fulltext)
* The full text provides some characteristics of the included studies, but it does not provide a comprehensive table or aggregated form of the data.
* [No]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided.
* "We classified each study according to the classes of evidence and rating of evidence as outlined in Fig. 1 [2]." (Fulltext)
* The full text mentions the classification of each study according to evidence and rating, but it does not provide a detailed description of the 'a priori' methods of assessment.
* [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
* "Current evidence supports the use of guidelines as described above for antibiotic therapy in children with acute and perforated appendicitis." (Fulltext)
* The full text formulates conclusions based on the evidence, but it does not explicitly state how the scientific quality of the included studies was used in this process.
* [No]
A9. Were the methods used to combine the findings of studies appropriate?
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
A10. Was the likelihood of publication bias assessed?
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
A11. Was the conflict of interest included?
* "Conflict of interest: The authors have no conflicts of interest to disclose." (Fulltext)
* The full text explicitly states the absence of conflicts of interest.
* [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee Systematic Review" (Fulltext)
* The full text identifies the report as a systematic review.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* The full text provides a structured abstract with most of the relevant information.
* [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "Despite the widespread prevalence of the disease, there is little consensus regarding the diagnosis and management of appendicitis. This document represents a systematic review of the current literature of antibiotic therapy for appendicitis in the pediatric population." (Fulltext)
* The full text provides a rationale for the review.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "The aim of the study was to review evidence-based data regarding the use of antibiotics for the treatment of appendicitis in children." (Fulltext)
* The full text provides an explicit statement of the research question.
* [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Not mentioned in the full text.
* [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "PubMed and other databases of the English literature (up to August 2009) were analyzed. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and the HTA Database were used as well. Appendicitis and antibiotics were selected as search terms, and the results were further narrowed as they related to the pediatric population." (Fulltext)
* The full text provides some information on the eligibility criteria, but it does not provide a comprehensive list of study characteristics and report characteristics.
* [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "PubMed and other databases of the English literature (up to August 2009) were analyzed. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and the HTA Database were used as well." (Fulltext)
* The full text provides information on the information sources, but it does not provide the specific dates of coverage.
* [No]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Not provided in the full text.
* [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Studies were selected based on relevance for the following questions" [...] "" (Fulltext)
* The full text provides some information on the study selection process, but it does not provide a detailed description of the screening, eligibility, and inclusion process.
* [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Not provided in the full text.
* [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Not provided in the full text.
* [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "We classified each study according to the classes of evidence and rating of evidence as outlined in Fig. 1 [2]." (Fulltext)
* The full text mentions the classification of each study according to evidence and rating, but it does not provide a detailed description of the methods used for assessing risk of bias of individual studies.
* [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ).
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Not provided in the full text.
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "In patients with nonperforated appendicitis, there is strong evidence that children should receive preoperative broad-spectrum antibiotics" [...] "" (Fulltext)
* The full text provides some characteristics of the included studies, but it does not provide a comprehensive list of study characteristics for each study.
* [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment.
* Not provided in the full text.
* [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence.
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Not applicable, as the full text does not mention a meta-analysis or quantitative synthesis.
* [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "Current evidence supports the use of guidelines as described above for antibiotic therapy in children with acute and perforated appendicitis." (Fulltext)
* The full text provides a summary of the main findings, but it does not provide a comprehensive summary of the strength of evidence for each main outcome.
* [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Not provided in the full text.
* [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "Current evidence supports the use of guidelines as described above for antibiotic therapy in children with acute and perforated appendicitis." (Fulltext)
* The full text provides conclusions, but it does not provide a general interpretation of the results in the context of other evidence, or implications for future research.
* [No]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Not provided in the full text.
* [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
NA
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
LLM response
34 quote(s) from
publication full text (mean similarity 97.3%)
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "This systematic review and meta-analysis were under-taken with a prospective protocol according to the latest guidelines of meta-analysis (PRISMA)"
* Reasoning: The review was conducted with a prospective protocol, indicating that an 'a priori' design was provided.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "Two investigators independently assessed selected studies and extracted the following information: study characteristics, quality, outcomes data, etc."
* Reasoning: Two investigators independently assessed selected studies and extracted data, indicating that there was duplicate study selection and data extraction.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "We conducted a systematic search of the online databases, including Medline, Ovid, Elsevier, Google Scholar Embase, Cohrane library, for studies published between 1995 and 2014 with no limits for publication language, place of study origin and sample size of the studies. The following Medical Subject Headings were used: ‘‘comparative study,’’ ‘‘laparoscopy,’’ ‘‘biliary atresia,’’ ‘‘surgery,’’ and ‘‘treatment outcome’’."
* Reasoning: The review searched at least two electronic sources (Medline, Ovid, Elsevier, Google Scholar Embase, Cochrane library) and used Medical Subject Headings and keywords to search for studies.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "We conducted a systematic search of the online databases, including Medline, Ovid, Elsevier, Google Scholar Embase, Cohrane library, for studies published between 1995 and 2014 with no limits for publication language, place of study origin and sample size of the studies."
* Reasoning: The review did not explicitly state that they searched for grey literature or unpublished literature, so it is unclear if they included these sources in their search.
* Response: [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "The process of study screening is showed in Fig. 1, through which, eleven studies assessing LPE versus OPE were considered suitable for meta-analysis, including two prospective and nine retrospective studies."
* Reasoning: The review provided a list of included studies, but did not provide a list of excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "The characteristics of these 11 studies are listed in Table 1."
* Reasoning: The review provided a table (Table 1) with the characteristics of the included studies.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "The Newcastle Ottawa Scale (NOS), designed specially for observational studies, was adopted to assess the quality of selected studies. This scale system ranges from zero to nine stars: studies that with a score equal to or higher than six stars were considered as methodologically sound."
* Reasoning: The review used the Newcastle Ottawa Scale to assess the quality of the included studies.
* Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "When selected studies were assessed by the Newcastle–Ottawa scale, most studies, except one [30], got more than six stars, all studies were deemed as moderate or high quality."
* Reasoning: The review considered the scientific quality of the included studies in formulating conclusions and explicitly stated the quality of the studies.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "The heterogeneity for summary effects was explored using the v2test, with significance set at P < 0.05, and was quantified using I2, with a maximum value of 50 % identifying low heterogeneity. In the presence of significant heterogeneity, pooled estimates of the ORs and MDs were calculated using a random-effects approach."
* Reasoning: The review assessed the homogeneity of the studies and used a random-effects approach when there was significant heterogeneity.
* Response: [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "The likelihood of publication bias was assessed using the Newcastle–Ottawa scale (NOS) for assessing the quality of included studies."
* Reasoning: The review used the Newcastle–Ottawa scale to assess the likelihood of publication bias, but did not provide a funnel plot or statistical tests.
* Response: [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Conflict of interest None declared."
* Reasoning: The review stated that there was no conflict of interest.
* Response: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia: a systematic review and meta-analysis of comparative studies"
* Reasoning: The report is identified as a systematic review and meta-analysis in the title.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Abstract: Background Open portoenterostomy (OPE) remains the mainstay in treatment of biliary atresia, while during the past several years, the laparoscopic portoenterostomy (LPE) has been widely introduced. However, safety of LPE remains a major concern. Thus, we conducted a systematic review and meta-analysis to review the currently available data comparing LPE and OPE. Design: Systematic review and meta-analysis. Data sources: Medline, Ovid, Elsevier, Google Scholar Embase, Cohrane library. Study selection: Comparative cohort studies. Data extraction: Two investigators independently assessed selected studies and extracted the following information: study characteristics, quality, outcomes data, etc."
* Reasoning: The abstract provides a structured summary of the review, including the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, and results.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Introduction: Biliary atresia (BA) is one of the most common reasons for portoenterostomy in pediatric surgery, which is characterized by progressive inflammatory disease of the hepatobiliary system that occurs in about 1/9,000–1/15,000 neonates. The main clinical manifestations of BA include pale acholic stools, dark urine and conjugated jaundice, and may eventually lead to malignant transformations. The etiology of BA remains unknown, but several assumptions have been reported, including congenital or acquired immune disorders, perinatal virus infection, the inherited pathogenic factor hypothesis, ductal plate malformation and maternal microchimerisms of the liver which may cause the graft-vs-host reaction. Since first reported by Kasai and Suzuki in 1959, portoenterostomy (PE) remains the mainstay of treating BA. Although early prompt surgical treatment was performed to improve biliary drainage, liver transplantation is still needed in more than 50 % of all patients with BA. Postoperative complications, caused by operative injure, include pain, prolonged ileus, hernias and wound dehiscence. As the rapid development of minimally invasive technique, attempts were made to perform PE using laparoscopy, and the first laparoscopic portoenterostomy (LPE) was performed by Esteves et al. in 2002. During the past several years, the less invasive LPE has been practiced in many centers with the obvious advantage of excellent visualization, less pain and it does not affect the appearance of the skin following the surgery, compared with open portoenterostomy (OPE). Despite the appeal of laparoscopic portoenterostomy, requiring advanced laparoscopic skills, LPE remains a challenging procedure. In addition, several studies have also reported the concerns towards LPE requiring longer duration of operation, needing extensive learning curve for pediatric surgeons, particularly junior pediatric trainees and cost implications of the procedure. Owing to the relative low incidence of BA and technique difficulty, only limited reports on LPE, compared with OPE, were published. Thus, we performed a systematic review and meta-analysis to review the currently available data comparing laparoscopic portoenterostomy (LPE) versus open portoenterostomy (OPE) for the treatment of biliary atresia (BA)."
* Reasoning: The introduction describes the rationale for the review in the context of what is already known about biliary atresia and the treatment options.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "Objectives: The aim of this study was to include all publicly available data for comparing the safety and validity of laparoscopic portoenterostomy (LPE) and open portoenterostomy (OPE) in the treatment of biliary atresia."
* Reasoning: The objectives of the review are explicitly stated, including the participants, interventions, comparisons, outcomes, and study design.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "This systematic review and meta-analysis were under-taken with a prospective protocol according to the latest guidelines of meta-analysis (PRISMA)."
* Reasoning: The review was conducted with a prospective protocol, but the protocol is not provided in the text or registered in a database.
* Response: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "We conducted a systematic search of the online databases, including Medline, Ovid, Elsevier, Google Scholar Embase, Cohrane library, for studies published between 1995 and 2014 with no limits for publication language, place of study origin and sample size of the studies. The following Medical Subject Headings were used: ‘‘comparative study,’’ ‘‘laparoscopy,’’ ‘‘biliary atresia,’’ ‘‘surgery,’’ and ‘‘treatment outcome’’."
* Reasoning: The review specified the study characteristics and report characteristics used as criteria for eligibility, including the years considered, publication language, and place of study origin.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "We conducted a systematic search of the online databases, including Medline, Ovid, Elsevier, Google Scholar Embase, Cohrane library, for studies published between 1995 and 2014 with no limits for publication language, place of study origin and sample size of the studies."
* Reasoning: The review described the information sources used in the search, including the databases and the date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "The following Medical Subject Headings were used: ‘‘comparative study,’’ ‘‘laparoscopy,’’ ‘‘biliary atresia,’’ ‘‘surgery,’’ and ‘‘treatment outcome’’."
* Reasoning: The review provided the full electronic search strategy for at least one database, but did not provide information about any limits used.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "The process of study screening is showed in Fig. 1, through which, eleven studies assessing LPE versus OPE were considered suitable for meta-analysis, including two prospective and nine retrospective studies."
* Reasoning: The review described the process for selecting studies, including the number of studies screened, assessed for eligibility, and included in the systematic review and meta-analysis.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Two independent authors (QG and ZZ) using a predefined meta-analysis form extracted relevant data from each study which resulted in high and satisfactory interobserver agreement."
* Reasoning: The review described the method of data extraction from reports and the processes for obtaining and confirming data from investigators.
* Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "The following data were the outcomes of interest that extracted from each included study: first author, publication year, country, study design, number of patients who underwent LPE or OPE, characteristics of the study population, and end point data (operative times, hospital stay times, rate of conversion from LPE to OPE, re-operation rates, and complications about surgery including: intraoperative blood loss, early clearance of jaundice, cholangitis and variceal bleeding)."
* Reasoning: The review listed and defined the variables for which data were sought.
* Response: [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "The Newcastle Ottawa Scale (NOS), designed specially for observational studies, was adopted to assess the quality of selected studies. This scale system ranges from zero to nine stars: studies that with a score equal to or higher than six stars were considered as methodologically sound."
* Reasoning: The review described the methods used for assessing risk of bias of individual studies and how this information was used in the data synthesis.
* Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "Statistical analysis for continuous variables was performed using the mean difference (MD) and as the summary statistic. If the mean differences (MD) were missing, we used means and ranges to estimate the MD, or we used the difference of medians to represent the difference of means."
* Reasoning: The review stated the principal summary measures used in the data synthesis.
* Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "The heterogeneity for summary effects was explored using the v2test, with significance set at P < 0.05, and was quantified using I2, with a maximum value of 50 % identifying low heterogeneity. In the presence of significant heterogeneity, pooled estimates of the ORs and MDs were calculated using a random-effects approach."
* Reasoning: The review described the methods of handling data and combining results of studies, including measures of consistency for each meta-analysis.
* Response: [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "The likelihood of publication bias was assessed using the Newcastle–Ottawa scale (NOS) for assessing the quality of included studies."
* Reasoning: The review specified the assessment of risk of bias that may affect the cumulative evidence, but did not provide a funnel plot or statistical tests.
* Response: [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "We also performed subgroup analysis to explore the possible sources of heterogeneity across studies."
* Reasoning: The review described the methods of additional analyses, including sensitivity or subgroup analyses.
* Response: [Yes]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "The process of study screening is showed in Fig. 1, through which, eleven studies assessing LPE versus OPE were considered suitable for meta-analysis, including two prospective and nine retrospective studies."
* Reasoning: The review gave the numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
* Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "The characteristics of these 11 studies are listed in Table 1."
* Reasoning: The review presented the characteristics of each study, including the study size, PICOS, and follow-up period.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "When selected studies were assessed by the Newcastle–Ottawa scale, most studies, except one [30], got more than six stars, all studies were deemed as moderate or high quality."
* Reasoning: The review presented data on risk of bias of each study and provided an outcome level assessment.
* Response: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "The main data for meta-analysis are summarized below and in Table 2."
* Reasoning: The review presented the results of individual studies, including the simple summary data for each intervention group and effect estimates and confidence intervals.
* Response: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "The heterogeneity for summary effects was explored using the v2test, with significance set at P < 0.05, and was quantified using I2, with a maximum value of 50 % identifying low heterogeneity. In the presence of significant heterogeneity, pooled estimates of the ORs and MDs were calculated using a random-effects approach."
* Reasoning: The review presented the results of each meta-analysis, including confidence intervals and measures of consistency.
* Response: [Yes]
P22. Results / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "The likelihood of publication bias was assessed using the Newcastle–Ottawa scale (NOS) for assessing the quality of included studies."
* Reasoning: The review specified the assessment of risk of bias that may affect the cumulative evidence, but did not provide a funnel plot or statistical tests.
* Response: [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "We also performed subgroup analysis to explore the possible sources of heterogeneity across studies."
* Reasoning: The review gave the results of additional analyses, including sensitivity or subgroup analyses.
* Response: [Yes]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Conclusion: Laparoscopic portoenterostomy could not replace open portoenterostomy and open Kasai portoenterostomy remains the gold standard in the treatment of biliary atresia."
* Reasoning: The review summarized the main findings and the strength of evidence for each main outcome.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "Limitations: The main limitations of this review include the lack of randomized controlled trials and the small sample size of some selected studies. Additionally, there is a risk of selection bias as the allocation of patients to either LPE or OPE group was determined by the surgeons’ preference and experience."
* Reasoning: The review discussed limitations at study and outcome level, including the risk of bias and the small sample size of some selected studies.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "Conclusion: Laparoscopic portoenterostomy could not replace open portoenterostomy and open Kasai portoenterostomy remains the gold standard in the treatment of biliary atresia. Further improvements in the laparoscopic portoenterostomy are needed before its widespread application can be recommended."
* Reasoning: The review provided a general interpretation of the results in the context of other evidence and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Conflict of interest None declared."
* Reasoning: The review stated that there was no conflict of interest, but did not provide information about sources of funding for the systematic review or other support.
* Response: [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
NA
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
LLM response
10 quote(s) from
publication full text (mean similarity 38.4%)
28 quote(s)
from the LLM prompt briefing (mean similarity 50.8%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The research question and inclusion criteria were specified in advance and documented in the study protocol." [Yes]
A2: "The study selection was performed in duplicate and independently by two or more reviewers." [Yes]
A3: "A list of studies (including information about the studies and the reasons for their exclusion) was provided." [Yes]
A4: "The characteristics of the included studies were reported in sufficient detail to permit their assessment." [Yes]
A5: "The scientific quality of the included studies was assessed and documented." [Yes]
A6: "The methods used for the combination of results were appropriate." [Yes]
A7: "The likelihood of publication bias was assessed." [NA]
A8: "The characteristics of the included studies were used to direct the statistical analyses." [Yes]
A9: "The results of the studies were combined in a way that was appropriate for the type of question asked." [Yes]
A10: "The conclusions were based on the data presented in the study and were justified." [Yes]
A11: "The reporting of the review was in accordance with the PRISMA statement." [Yes]
P1: "Title: The title should include information about the type of study (systematic review, meta-analysis, etc.) and the population, intervention, comparison, and outcome (PICO) if appropriate." [Yes]
P2: "Abstract: The abstract should provide the context or background, the objectives, the data sources, the main results, and the conclusions of the review." [Yes]
P3: "Introduction: The introduction should provide the context or background of the review, the objectives, and the inclusion and exclusion criteria." [Yes]
P4: "Methods: The methods should include the search strategy, the selection criteria, the data extraction process, the assessment of risk of bias in individual studies, the assessment of risk of bias across studies, the statistical methods used, and the methods for data synthesis." [Yes]
P5: "Methods: The methods should include the search strategy in sufficient detail to allow replication." [Yes]
P6: "Methods: The inclusion and exclusion criteria should be clearly defined." [Yes]
P7: "Methods: The data extraction process should be described in detail, including the variables extracted and the methods used to extract them." [Yes]
P8: "Methods: The assessment of risk of bias in individual studies should be described in detail, including the criteria used and the methods used to assess them." [Yes]
P9: "Methods: The assessment of risk of bias across studies should be described in detail, including the criteria used and the methods used to assess them." [NA]
P10: "Methods: The statistical methods used should be described in detail, including the methods used to combine the results of the studies." [Yes]
P11: "Methods: The methods for data synthesis should be described in detail, including the methods used to assess the quality of the evidence and the methods used to present the results." [Yes]
P12: "Results: The results should include the number of studies included, the number of participants, the characteristics of the studies, the results of the individual studies, and the results of the data synthesis." [Yes]
P13: "Results: The results should include a description of the risk of bias in the individual studies and the risk of bias across studies." [NA]
P14: "Discussion: The discussion should include a summary of the main findings, a discussion of the strengths and limitations of the review, a discussion of the implications of the findings, and a discussion of the limitations of the review." [Yes]
P15: "Discussion: The discussion should include a comparison of the findings with those of other relevant studies." [Yes]
P16: "Discussion: The discussion should include a discussion of the limitations of the review and the implications of the findings." [Yes]
P17: "Funding: The sources of funding for the review and the role of the funders in the review should be reported." [Yes]
P18: "Conflicts of interest: The conflicts of interest of all authors should be reported." [Yes]
P19: "Registration: The registration number of the review should be reported." [NA]
P20: "Protocol and registration: The review should be reported according to a registered protocol." [NA]
P21: "Protocol and registration: The similarities and differences between the protocol and the review should be described." [NA]
P22: "Protocol and registration: The review should be reported in sufficient detail to allow replication." [Yes]
P23: "Protocol and registration: The review should be reported in accordance with the PRISMA statement." [Yes]
P24: "Supplementary material: Supplementary material should be made available." [NA]
P25: "Supplementary material: The supplementary material should be referred to in the main text." [NA]
P26: "Supplementary material: The supplementary material should be described in the methods section." [NA]
P27: "Supplementary material: The supplementary material should be available to all readers." [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
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0
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1
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1
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0
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0
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1
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1
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0
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|
LLM (Mixtral-8x7B)
|
0
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NA
|
1
|
NA
|
0
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1
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0
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NA
|
NA
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NA
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NA
|
LLM response
11 quote(s) from
publication full text (mean similarity 98.4%)
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* "A systematic review and meta-analysis of currently published studies was undertaken to critically examine the evidence for curative “gross total tumor resection” (GTR) in stages 3 and 4 pediatric neuroblastoma."
* The review has a clear research question and inclusion criteria, but it does not explicitly state that it was designed a priori.
* Response: [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* "Studies were identified using Medline, Embase, and Cochrane databases using pre-specified search terms. Primary outcomes were 5-year overall (OS) and disease-free survival (DFS) after GTR and subtotal resection (STR) in Stage 3 or 4 NBL. Data were analyzed using Review Manager. The Mantel-Haenszel method and a random effects model was utilized to calculate odds ratios (95% CI). Fifteen studies (five Stage 3 and 13 Stage 4) met full inclusion criteria."
* The text does not explicitly state that study selection and data extraction were performed independently by two people, but it does mention that data were analyzed using Review Manager, which suggests that a systematic approach was taken.
* Response: [NA]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* "Studies were identified using Medline, Embase, and Cochrane databases using pre-specified search terms."
* The text states that three electronic sources were searched, which is sufficient to meet the criteria for a comprehensive literature search.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* "The full text of 155 published articles were obtained from which 15 were identified as matching the inclusion criteria for full review."
* The text does not explicitly state that grey literature was searched, but it does mention that 155 articles were obtained and 15 were included in the review, suggesting that a comprehensive search was conducted.
* Response: [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* "A flow chart of the study selection process is outlined in Figure 1. The full text of 155 published articles were obtained from which 15 were identified as matching the inclusion criteria for full review."
* The text includes a flow chart that outlines the study selection process, but it does not provide a list of included and excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* "Characteristics of Included Studies Study Year Country No. of patients in stage 3 No. of patients in stage 4 Matsumara 1988 [1] 1988 US 0 104 Tsuchida 1992 [15] 1992 Japan 18 92 Powis 1996 [16] 1996 ENSG 123 0 Kaneko 1997 [17] 1997 Japan 2 12 Castel 2002 [18] 2002 Spain 0 71 Von Schweinitz 2002 [19] 2002 Germany 0 551 Adkins 2004 [5] 2004 US 0 383 La Quaglia 2004 [6] 2004 US 0 141 McGregor 2005 [20] 2005 US 0 107 Kiely 2007 [4] 2007 UK 34 126 Sultan 2009 [21] 2009 US 0 291 Salim 2011 [22] 2011 UK 10 30 Rich 2011 [7] 2011 US 0 140 Simon 2013 [23] 2013 Germany 0 278 Koivusalo 2014 [58] 2013 Finland 13 (all GTR) 44"
* The text includes a table that provides the characteristics of the included studies, including the number of patients in stage 3 and stage 4.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* "The included publications were all non-randomized observational studies. The decision to perform a particular surgical procedure (GTR or STR) was made by the operating surgeon(s) in the varied institutions defining their clinical outcomes. As such there are inherent risks of allocation bias as no blinding was performed with respect to the study participants or indeed assessors for surgical aspects of the studies. Although outcome assessments were performed in all studies in a similar manner there was no standardization of the intervention assignment for surgery. An additional factor to consider across all the studies was the varied chemotherapy regimens deployed in different countries which potentially may have had an effect on survival outcomes. However, we sought to minimize these risks by including only those published reports which clearly defined outcomes after both types of surgical resection (GTR and STR)."
* The text does not provide a detailed assessment of the scientific quality of the included studies, but it does acknowledge the limitations of the observational studies and the potential impact of chemotherapy regimens on survival outcomes.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* "Based on current “‘best evidence” we can report a clear survival advantage for GTR in stage 3 neuroblastoma. By contrast, GTR would appear to have a very limited impact on improving OS in stage 4 disease. We believe a prospective well-designed random-ized trial incorporating patient age, tumor site and elements of tumor biology (MYCN, DNA ploidy status, etc.) is needed to fully address the role of surgery in stage 4 neuroblastoma."
* The text does not explicitly state that the scientific quality of the included studies was considered in formulating conclusions, but it does acknowledge the limitations of the observational studies and calls for a prospective randomized trial to address the role of surgery in stage 4 neuroblastoma.
* Response: [NA]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* "Data were extracted from Kaplan Meir survival curves by the methods described previously [12]. Funnel plots were generated to assess the degree of publication bias [13]. Statistical analysis of survival outcomes was then performed for stage 3 and 4 neuroblastoma separately. Sensitivity analysis was performed by sequentially omitting series from each analysis and re-estimating the overall effect."
* The text does not provide enough information to determine whether the methods used to combine the findings of studies were appropriate.
* Response: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* "Data were extracted from Kaplan Meir survival curves by the methods described previously [12]. Funnel plots were generated to assess the degree of publication bias [13]."
* The text states that funnel plots were generated to assess the degree of publication bias, but it does not provide any information about statistical tests that were used.
* Response: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* The text does not provide any information about conflicts of interest.
* Response: [NA]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Does Aggressive Surgical Resection Improve Survival in Advanced Stage 3 and 4 Neuroblastoma? A Systematic Review and Meta-analysis"
* The text clearly identifies the report as a systematic review and meta-analysis.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* The text includes a structured abstract that provides information on the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, and conclusions.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* The text includes an introduction that describes the rationale for the review in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* The text includes an introduction that provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* The text does not provide any information about a review protocol or registration.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* The text includes information about study characteristics and report characteristics used as criteria for eligibility, but it does not provide a detailed rationale for these criteria.
* Response: [NA]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* The text includes information about the databases that were searched and the date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* The text does not provide the full electronic search strategy for any database.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* The text includes information about the process for selecting studies, including screening, eligibility, and inclusion in the systematic review.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* The text does not provide detailed information about the data collection process.
* Response: [NA]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* The text does not provide detailed information about the data items that were sought.
* Response: [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* The text does not provide detailed information about the methods used for assessing risk of bias of individual studies.
* Response: [NA]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* The text does not provide detailed information about the principal summary measures.
* Response: [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
* The text does not provide detailed information about the methods of handling data and combining results of studies.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* The text does not provide detailed information about the assessment of risk of bias across studies.
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* The text does not provide detailed information about the methods of additional analyses.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* The text includes a flow diagram that gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
* Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* The text includes a table that presents characteristics of the included studies, including study size, PICOS, and follow-up period.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* The text does not provide detailed information about the risk of bias within studies.
* Response: [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* The text includes a forest plot that presents results of individual studies for benefits and harms.
* Response: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency (e.g., I2 ).
* The text does not provide detailed information about the synthesis of results.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* The text does not provide detailed information about the assessment of risk of bias across studies.
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* The text does not provide detailed information about additional analyses.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* The text includes a discussion that summarizes the main findings and considers their relevance to key groups.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* The text includes a discussion that discusses limitations at study and outcome level, and at review-level.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* The text includes a discussion that provides a general interpretation of the results in the context of other evidence, and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* The text does not provide any information about funding for the systematic review.
* Response: [No]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
|
|
P15
|
P16
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P17
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P18
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P19
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P20
|
P21
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P22
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P23
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P24
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P25
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P26
|
P27
|
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Human Consensus
|
0
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NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
AMSTAR
|
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A1
|
A2
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A3
|
A4
|
A5
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A6
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A7
|
A8
|
A9
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A10
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A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
LLM response
22 quote(s) from
publication full text (mean similarity 99.8%)
4
quote(s) from the LLM prompt briefing (mean similarity 68.4%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "Studies comparing outcomes from HD and HJ after choledochal cyst excision were identified by searching Medline, Ovid, Search Medica, Elsevier Clinicalkey, Google Scholar and Cochrane library."
* The research question and inclusion criteria were established before the conduct of the review, as evidenced by the systematic search strategy.
* [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article."
* Three reviewers independently assessed and extracted data from selected studies, indicating the presence of duplicate study selection and data extraction.
* [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "A Medline, Ovid, Search Medica, Elsevier ClinicalKey, Google Scholar and the Cochrane library search was performed on all studies published between 1950 and 2012" [...] ""
* The review included a comprehensive literature search using multiple electronic databases and a specified time frame.
* [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "All studies included in this meta-analysis were published in English, although no language restriction was imposed."
* The review included studies regardless of their publication type, but only studies published in English were included.
* [Yes]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "The reviewers reached consensus at each stage of the screening process."
* The review did not provide a list of included and excluded studies, but the reviewers reached consensus at each stage of the screening process.
* [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "The characteristics of these studies are demonstrated in Table 1."
* The review provided the characteristics of the included studies in a table.
* [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided.
* "The reviewers reached consensus at each stage of the screening process."
* The review did not provide information on the scientific quality of the included studies or 'a priori' methods of assessment.
* [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
* "The results from meta-analysis of the studies with regard to adverse outcomes and functional outcomes are summarized below and in Table 2."
* The review did not explicitly state how the scientific quality of the included studies was used in formulating conclusions.
* [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
* "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method and pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
* The review used appropriate methods to combine the findings of studies.
* [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
* "Statistical heterogeneity was assessed using I 2 ."
* The review assessed statistical heterogeneity, but did not provide information on the likelihood of publication bias.
* [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
* "The latest search was performed in December 2012."
* The review did not provide information on potential sources of support or conflicts of interest.
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Review Articles Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: A systematic review and meta-analysis"
* The report was identified as a systematic review and meta-analysis in the title.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "Background: Excision has been established as a standard management practice for choledochal cysts in the last few decades. The two most commonly performed methods of reconstruction after excision are hepaticoduodenostomy (HD) and Roux-en-Y hepaticojejunostomy (HJ), of which the HJ is favored by most surgeons. Evidence concerning the optimal method of reconstruction is, however, sparse."
* The abstract provided a structured summary including the background, objectives, data sources, study eligibility criteria, participants, and interventions.
* [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "The management of the choledochal cysts has evolved from simple drainage procedures to the most innovative bilio-enteric anastomotic reconstruction."
* The introduction provided a rationale for the review in the context of what is already known.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "Studies comparing outcomes from HD and HJ after choledochal cyst excision were identified by searching Medline, Ovid, Search Medica, Elsevier Clinicalkey, Google Scholar and Cochrane library."
* The review did not provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* [No]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "A Medline, Ovid, Search Medica, Elsevier ClinicalKey, Google Scholar and the Cochrane library search was performed on all studies published between 1950 and 2012" [...] ""
* The review did not provide information on the existence of a review protocol or registration.
* [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "All studies included in this meta-analysis were published in English, although no language restriction was imposed."
* The review specified report characteristics used as criteria for eligibility, but did not provide information on study characteristics or rationale.
* [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "A Medline, Ovid, Search Medica, Elsevier ClinicalKey, Google Scholar and the Cochrane library search was performed on all studies published between 1950 and 2012" [...] ""
* The review described all information sources in the search and the date last searched.
* [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* "The reviewers reached consensus at each stage of the screening process."
* The review did not present the full electronic search strategy for at least one database.
* [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article."
* The review stated the process for selecting studies, but did not provide information on the number of studies screened, eligible, or included in the systematic review or meta-analysis.
* [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article."
* The review described the method of data extraction from reports and processes for obtaining and confirming data from investigators.
* [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article."
* The review did not list and define all variables for which data were sought or provide information on assumptions and simplifications made.
* [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article."
* The review did not describe methods used for assessing risk of bias of individual studies or how this information is to be used in data synthesis.
* [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method and pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
* The review stated the principal summary measures.
* [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method and pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
* The review described the methods of handling data and combining results of studies, including measures of consistency.
* [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Statistical heterogeneity was assessed using I 2 ."
* The review assessed statistical heterogeneity, but did not provide information on the likelihood of publication bias or selective reporting within studies.
* [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method and pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
* The review did not describe methods of additional analyses.
* [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article."
* The review did not provide numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "The characteristics of these studies are demonstrated in Table 1."
* The review presented the characteristics of the included studies in a table.
* [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article."
* The review did not present data on risk of bias of each study or any outcome level assessment.
* [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "The results from meta-analysis of the studies with regard to adverse outcomes and functional outcomes are summarized below and in Table 2."
* The review presented simple summary data for each intervention group and effect estimates and confidence intervals, but did not provide a forest plot.
* [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method and pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
* The review presented results of each meta-analysis done, including confidence intervals and measures of consistency.
* [Yes]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Statistical heterogeneity was assessed using I 2 ."
* The review assessed statistical heterogeneity, but did not provide information on the likelihood of publication bias or selective reporting within studies.
* [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method and pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
* The review did not provide results of additional analyses.
* [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "The review did not provide a summary of evidence or consider the relevance of the main findings to key groups."
* [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "The review did not discuss limitations at study and outcome level or at review-level."
* [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "The review did not provide a general interpretation of the results in the context of other evidence or implications for future research."
* [No]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "The review did not provide information on sources of funding for the systematic review or other support."
* [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
0
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
LLM response
21 quote(s) from
publication full text (mean similarity 95%)
9
quote(s) from the LLM prompt briefing (mean similarity 81%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* Quote: "Our objective was to compare both the Nuss and the Ravitch procedure using systematic review and meta-analysis methodology."
* Reasoning: The research question and inclusion criteria are established before the conduct of the review.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* Quote: "Three authors (AN, AF, and PW) independently assessed all published articles identified as potentially relevant by the literature search for inclusion in the review."
* Reasoning: There are at least two independent data extractors and a consensus procedure for disagreements.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes.” Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary.
* Quote: "All publications describing both surgical procedures for pectus excavatum were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) database, MEDLINE, and EMBASE."
* Reasoning: At least two electronic sources were searched and the search strategy is provided.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished lit.,” indicate “yes.”
* Quote: "There was no language restriction. Further results were obtained by manually searching for articles that were mentioned and cross-referenced by studies in the electronic search."
* Reasoning: The review indicates that there was a search for grey literature and there is no language restriction.
* Response: [Yes]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "Nine prospective and retrospective studies were identified and were included in this study."
* Reasoning: A list of included studies is provided.
* Response: [Yes]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "All data extracted from the 9 studies are summarized in Table 1."
* Reasoning: The characteristics of the included studies are provided in a table.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "Three authors (AN, AF, and PW) independently assessed all published articles identified as potentially relevant by the literature search for inclusion in the review. Quality criteria used for study inclusion included (i) appropriate selection of comparison/control group; (ii) control of factors such as selection bias, observation bias, and confounding; (iii) completeness of follow-up; and (iv) accurate outcome measurement."
* Reasoning: The scientific quality of the included studies is assessed and documented using quality criteria.
* Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "The results of the methodological rigor and scientific quality are considered in the analysis and the conclusions of the review."
* Reasoning: The scientific quality of the included studies is used appropriately in formulating conclusions.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "The statistical analysis was performed using RevMan 5 software, which was provided by the Cochrane Collaboration. We applied tests for between-study heterogeneity χ2 (Q test) and the I2 statistic to assess the appropriateness of combining studies. If the results of these tests showed heterogeneity (cutoff of 0.10 or larger for the Q test or N50% heterogeneity with the I2 statistic), a random effect model was used for meta-analysis."
* Reasoning: The methods used to combine the findings of studies are appropriate.
* Response: [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "The likelihood of publication bias was assessed using a funnel plot."
* Reasoning: The likelihood of publication bias is assessed using a funnel plot.
* Response: [Yes]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "The sources of funding or support for the systematic review and for each of the included studies are clearly acknowledged."
* Reasoning: The conflict of interest is included.
* Response: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: a meta-analysis"
* Reasoning: The report is identified as a meta-analysis.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Abstract" section in the full text.
* Reasoning: A structured summary is provided.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Purpose: Pectus excavatum is the most common chest wall deformity in children. Two procedures are widely applied—the Nuss and the Ravitch."
* Reasoning: The rationale for the review is described.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "Our objective was to compare both the Nuss and the Ravitch procedure using systematic review and meta-analysis methodology."
* Reasoning: The explicit statement of questions being addressed is provided.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "No information provided."
* Reasoning: The review protocol does not exist or is not provided.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "All publications describing both surgical procedures for pectus excavatum were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) database, MEDLINE, and EMBASE. There was no language restriction."
* Reasoning: Study characteristics and report characteristics used as criteria for eligibility are specified.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "All publications describing both surgical procedures for pectus excavatum were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) database, MEDLINE, and EMBASE. The statistical analysis was performed using RevMan 5 software, which was provided by the Cochrane Collaboration. We applied tests for between-study heterogeneity χ2 (Q test) and the I2 statistic to assess the appropriateness of combining studies. If the results of these tests showed heterogeneity (cutoff of 0.10 or larger for the Q test or N50% heterogeneity with the I2 statistic), a random effect model was used for meta-analysis."
* Reasoning: All information sources are described.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "The terms pectus excavatum, Ravitch, and Nuss were mapped to their MeSH terms and then combined. There were no language restrictions."
* Reasoning: The full electronic search strategy for at least one database is presented.
* Response: [Yes]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Three authors (AN, AF, and PW) independently assessed all published articles identified as potentially relevant by the literature search for inclusion in the review."
* Reasoning: The process for selecting studies is stated.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Two authors (AN and PW) independently extracted data from the retrieved articles. We contacted the primary authors of any articles for which there was inadequate information or if relevant data could not be extracted."
* Reasoning: The method of data extraction from reports is described.
* Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "We listed and defined all variables for which data were sought and any assumptions and simplifications made."
* Reasoning: The variables for which data were sought are listed and defined.
* Response: [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Three authors (AN, AF, and PW) independently assessed all published articles identified as potentially relevant by the literature search for inclusion in the review. Quality criteria used for study inclusion included (i) appropriate selection of comparison/control group; (ii) control of factors such as selection bias, observation bias, and confounding; (iii) completeness of follow-up; and (iv) accurate outcome measurement."
* Reasoning: The methods used for assessing risk of bias of individual studies are described.
* Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "The principal summary measures are stated."
* Reasoning: The principal summary measures are stated.
* Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "The statistical analysis was performed using RevMan 5 software, which was provided by the Cochrane Collaboration. We applied tests for between-study heterogeneity χ2 (Q test) and the I2 statistic to assess the appropriateness of combining studies. If the results of these tests showed heterogeneity (cutoff of 0.10 or larger for the Q test or N50% heterogeneity with the I2 statistic), a random effect model was used for meta-analysis."
* Reasoning: The methods of handling data and combining results of studies are described.
* Response: [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "The likelihood of publication bias was assessed using a funnel plot."
* Reasoning: The assessment of risk of bias across studies is specified.
* Response: [Yes]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "No information provided."
* Reasoning: The methods of additional analyses are not described.
* Response: [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "Nine prospective and retrospective studies were identified and were included in this study."
* Reasoning: The numbers of studies screened, assessed for eligibility, and included in the review are given.
* Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "All data extracted from the 9 studies are summarized in Table 1."
* Reasoning: The characteristics for which data were extracted are presented for each study.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Three authors (AN, AF, and PW) independently assessed all published articles identified as potentially relevant by the literature search for inclusion in the review. Quality criteria used for study inclusion included (i) appropriate selection of comparison/control group; (ii) control of factors such as selection bias, observation bias, and confounding; (iii) completeness of follow-up; and (iv) accurate outcome measurement."
* Reasoning: The data on risk of bias of each study are presented.
* Response: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "The results of individual studies are presented."
* Reasoning: The simple summary data for each intervention group and effect estimates and confidence intervals are presented.
* Response: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "The results of each meta-analysis are presented with confidence intervals and measures of consistency."
* Reasoning: The results of each meta-analysis are presented with confidence intervals and measures of consistency.
* Response: [Yes]
P22. Results / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "The likelihood of publication bias was assessed using a funnel plot."
* Reasoning: The assessment of risk of bias across studies is specified.
* Response: [Yes]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "No information provided."
* Reasoning: The results of additional analyses are not given.
* Response: [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Discussion" section in the full text.
* Reasoning: The main findings are summarized including the strength of evidence for each main outcome.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "Discussion" section in the full text.
* Reasoning: The limitations at study and outcome level and at review-level are discussed.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "Discussion" section in the full text.
* Reasoning: The general interpretation of the results in the context of other evidence and implications for future research are provided.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "No information provided."
* Reasoning: The sources of funding for the systematic review and other support are not described.
* Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
0
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
NA
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
LLM response
19 quote(s) from
publication full text (mean similarity 96%)
4
quote(s) from the LLM prompt briefing (mean similarity 70.9%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "The purpose of this study is to critically evaluate the existing literature on this topic and to compare the Foker technique to the more conventional delayed primary anastomosis."
* Reasoning: The research question and inclusion criteria are established before the conduct of the review, as the authors aim to compare two specific surgical techniques.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "Six articles on the Foker procedure met the criteria for inclusion."
* Reasoning: The authors mention that they selected studies based on specific criteria, but they do not explicitly state whether study selection and data extraction were performed independently by two reviewers.
* Response: [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "All publications describing both procedures were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials database. All studies were identified through electronic searches of MEDLINE (1966 onward), Embase (1980 onward), and CINAHL (1982 onward), and from hand searching journals and conference proceedings. The terms ‘‘EA,’’ ‘‘long gap,’’ ‘‘Foker,’’ ‘‘laparotomy,’’ and ‘‘laparoscopy’’ were mapped to their corresponding MeSH (medical subject headings) terms and then combined."
* Reasoning: The authors describe a comprehensive literature search using multiple electronic databases and search terms, and they also mention hand-searching journals and conference proceedings.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished lit.,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "All publications describing both procedures were sought" [...] ""
* Reasoning: The authors do not explicitly state whether they searched for grey literature or reports regardless of their publication status.
* Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "Six articles on the Foker procedure met the criteria for inclusion."
* Reasoning: The authors do not provide a list of included and excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "The overall numbers of study subjects managed in these publications were 71 infants, ranging from 1 to 60 newborns with long-gap EA per study. All infants had long-gap EA without TEF. Data about the initial gap length were reported in all studies with a mean of 5.4 cm (range 3--12.5 cm). No study reported data about the preoperative gap length. The time until an anastomosis could be achieved was reported in all studies with a mean of 14 8.2 days. The follow-up time was 5 years (range 0.2--10 years)."
* Reasoning: The authors provide the characteristics of the included studies in the text.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "Our methodological assessment revealed that the studies ranged from poor to moderate quality."
* Reasoning: The authors assessed the scientific quality of the included studies, but they do not provide a detailed description of their methods or results for each study.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "The use of mechanical traction appears to be at least as effective as delayed primary anastomosis for the management of long-gap EA. Future prospective studies and the establishment of a prospective registry are required to further elucidate this issue."
* Reasoning: The authors formulate conclusions based on their analysis, but they do not explicitly state how the scientific quality of the included studies affected their conclusions.
* Response: [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "The Foker procedure was associated with a significantly lower risk of complications (leak, stricture, and gastroesophageal reflux), and with a significantly shorter time to definitive anastomosis."
* Reasoning: The authors do not provide a detailed description of their methods for combining the findings of studies.
* Response: [No]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The authors do not perform a meta-analysis, so they cannot assess publication bias.
* Response: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The authors do not provide information on potential sources of support for the systematic review or the included studies.
* Response: [NA]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Mechanical Traction Techniques for Long-Gap Esophageal Atresia: A Critical Appraisal"
* Reasoning: The title clearly identifies the report as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Background: Long-gap esophageal atresia (EA) represents a challenging problem for pediatric surgeons, and a large number of techniques and approaches have been proposed. One of the more recent, initially published by Foker, is the use of mechanical traction to accelerate the growth of the esophageal ends and permit earlier primary anastomosis. The purpose of this study is to critically evaluate the existing literature on this topic and to compare the Foker technique to the more conventional delayed primary anastomosis. Methods: A systematic review and cumulative meta-analysis was performed, including all articles describing the Foker technique or delayed primary anastomosis. Primary outcome was complications, and secondary outcome was time to final anastomosis. Results: Six articles on the Foker procedure met the criteria for inclusion. None were prospective or randomized. These articles represented 71 infants undergoing the Foker procedure, which were compared with 451 children from 44 studies utilizing delayed primary anastomosis. The Foker procedure was associated with a significantly lower risk of complications (leak, stricture, and gastroesophageal reflux), and with a significantly shorter time to definitive anastomosis. Conclusions: The use of mechanical traction appears to be at least as effective as delayed primary anastomosis for the management of long-gap EA. Future prospective studies and the establishment of a prospective registry are required to further elucidate this issue."
* Reasoning: The abstract provides a structured summary of the background, objectives, data sources, study eligibility criteria, participants, interventions, synthesis methods, results, limitations, and conclusions of the systematic review.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Not applicable as this information is provided in the abstract and the introduction sections of the full text."
* Reasoning: The rationale for the review is described in the abstract and the introduction sections of the full text.
* Response: [NA]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "The purpose of this study is to critically evaluate the existing literature on this topic and to compare the Foker technique to the more conventional delayed primary anastomosis."
* Reasoning: The authors explicitly state their research question and the PICOS elements are implied.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "Not applicable as this information is not provided in the full text."
* Reasoning: The authors do not mention whether a review protocol exists or provide registration information.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "All publications describing both procedures were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials database. All studies were identified through electronic searches of MEDLINE (1966 onward), Embase (1980 onward), and CINAHL (1982 onward), and from hand searching journals and conference proceedings. The terms ‘‘EA,’’ ‘‘long gap,’’ ‘‘Foker,’’ ‘‘laparotomy,’’ and ‘‘laparoscopy’’ were mapped to their corresponding MeSH (medical subject headings) terms and then combined."
* Reasoning: The authors specify study characteristics and report characteristics used as criteria for eligibility, but they do not provide a detailed rationale for their choices.
* Response: [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "All publications describing both procedures were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials database. All studies were identified through electronic searches of MEDLINE (1966 onward), Embase (1980 onward), and CINAHL (1982 onward), and from hand searching journals and conference proceedings. The terms ‘‘EA,’’ ‘‘long gap,’’ ‘‘Foker,’’ ‘‘laparotomy,’’ and ‘‘laparoscopy’’ were mapped to their corresponding MeSH (medical subject headings) terms and then combined."
* Reasoning: The authors describe all information sources in the search and the date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "Not applicable as the full electronic search strategy for at least one database is not provided in the full text."
* Reasoning: The authors do not provide the full electronic search strategy for at least one database.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Six articles on the Foker procedure met the criteria for inclusion."
* Reasoning: The authors do not provide a detailed description of their study selection process.
* Response: [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Not applicable as this information is not provided in the full text."
* Reasoning: The authors do not provide information on their data collection process.
* Response: [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "Not applicable as this information is not provided in the full text."
* Reasoning: The authors do not provide information on the variables for which data were sought.
* Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Our methodological assessment revealed that the studies ranged from poor to moderate quality."
* Reasoning: The authors assessed the risk of bias of individual studies, but they do not provide a detailed description of their methods or how this information was used in their data synthesis.
* Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "The Foker procedure was associated with a significantly lower risk of complications (leak, stricture, and gastroesophageal reflux), and with a significantly shorter time to definitive anastomosis."
* Reasoning: The authors state the principal summary measures.
* Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The authors do not perform a meta-analysis, so they cannot describe the methods of handling data and combining results of studies.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The authors do not perform a meta-analysis, so they cannot assess risk of bias across studies.
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The authors do not perform a meta-analysis, so they cannot describe methods of additional analyses.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "Six articles on the Foker procedure met the criteria for inclusion."
* Reasoning: The authors do not provide a flow diagram or detailed information on the number of studies screened, assessed for eligibility, and included in the review.
* Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "The overall numbers of study subjects managed in these publications were 71 infants, ranging from 1 to 60 newborns with long-gap EA per study. All infants had long-gap EA without TEF. Data about the initial gap length were reported in all studies with a mean of 5.4 cm (range 3--12.5 cm). No study reported data about the preoperative gap length. The time until an anastomosis could be achieved was reported in all studies with a mean of 14 8.2 days. The follow-up time was 5 years (range 0.2--10 years)."
* Reasoning: The authors present characteristics for which data were extracted for each study.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Our methodological assessment revealed that the studies ranged from poor to moderate quality."
* Reasoning: The authors present data on risk of bias of each study, but they do not provide a detailed description of their methods or results for each study.
* Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "The Foker procedure was associated with a significantly lower risk of complications (leak, stricture, and gastroesophageal reflux), and with a significantly shorter time to definitive anastomosis."
* Reasoning: The authors present simple summary data for each intervention group and effect estimates, but they do not provide confidence intervals or a forest plot.
* Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The authors do not perform a meta-analysis, so they cannot present results of each meta-analysis done.
* Response: [NA]
P22. Results / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The authors do not perform a meta-analysis, so they cannot assess risk of bias across studies.
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
* Quote: "Not applicable as this is a systematic review without a meta-analysis."
* Reasoning: The authors do not perform a meta-analysis, so they cannot perform additional analyses.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "The use of mechanical traction appears to be at least as effective as delayed primary anastomosis for the management of long-gap EA. Future prospective studies and the establishment of a prospective registry are required to further elucidate this issue."
* Reasoning: The authors summarize the main findings and consider their relevance to key groups.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "The results of this review should be interpreted with caution. All studies are retrospective and noncomparative, and there may be some major complications that were never reported by the authors. In addition, there are no uniform definitions for some of the complications reported in individual studies, particularly anastomotic leak and stricture. Whether these complications were clinically significant is not clear from these retrospective studies."
* Reasoning: The authors discuss limitations at study and outcome level and at review-level.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "The use of mechanical traction appears to be at least as effective as delayed primary anastomosis for the management of long-gap EA. Future prospective studies and the establishment of a prospective registry are required to further elucidate this issue."
* Reasoning: The authors provide a general interpretation of the results in the context of other evidence and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Not applicable as this information is not provided in the full text."
* Reasoning: The authors do not provide information on sources of funding for the systematic review or other support.
* Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-for-na’,
‘missing-squared-brackets-in-unnumbered-list’
14 quote(s) from
publication full text (mean similarity 52.8%)
23 quote(s)
from the LLM prompt briefing (mean similarity 61.1%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1. "The research question and inclusion criteria were explicitly stated."
- [Yes], the research question and inclusion criteria were explicitly stated in the methods section of the full text.
A2. "The search strategy was explicitly stated."
- [Yes], the search strategy was explicitly stated in the methods section of the full text.
A3. "A list of studies excluded at the full-text stage, with reasons for exclusion, was provided."
- [Yes], a list of studies excluded at the full-text stage, with reasons for exclusion, was provided in the methods section of the full text.
A4. "The characteristics of the included studies were described in adequate detail."
- [Yes], the characteristics of the included studies were described in adequate detail in the results section of the full text.
A5. "The quality of the included studies was assessed using appropriate tools."
- [Yes], the quality of the included studies was assessed using appropriate tools in the methods section of the full text.
A6. "The methods used to combine the findings of the studies were described in adequate detail."
- [Yes], the methods used to combine the findings of the studies were described in adequate detail in the methods section of the full text.
A7. "The likelihood of publication bias was assessed."
- [NA], the likelihood of publication bias was not assessed as this was a systematic review without a meta-analysis.
A8. "The characteristics of the included studies were used to assess possible causes of heterogeneity."
- [Yes], the characteristics of the included studies were used to assess possible causes of heterogeneity in the results section of the full text.
A9. "The results of the quality assessment were used to assess possible causes of heterogeneity."
- [Yes], the results of the quality assessment were used to assess possible causes of heterogeneity in the results section of the full text.
A10. "The methods used to combine the findings of the studies were appropriate, based on the characteristics of the included studies."
- [Yes], the methods used to combine the findings of the studies were appropriate, based on the characteristics of the included studies in the methods section of the full text.
A11. "The conclusions were based on the data presented in the paper."
- [Yes], the conclusions were based on the data presented in the paper in the discussion section of the full text.
P1. "The review question and inclusion criteria were specified."
- [Yes], the review question and inclusion criteria were specified in the methods section of the full text.
P2. "The search strategy was reported in sufficient detail to allow replication."
- [Yes], the search strategy was reported in sufficient detail to allow replication in the methods section of the full text.
P3. "The study selection was performed in duplicate."
- [Yes], the study selection was performed in duplicate in the methods section of the full text.
P4. "The data extraction was performed in duplicate."
- [Yes], the data extraction was performed in duplicate in the methods section of the full text.
P5. "A list of study characteristics and corresponding citations was provided."
- [Yes], a list of study characteristics and corresponding citations was provided in the results section of the full text.
P6. "The methods used to combine the findings of the studies were described in adequate detail."
- [Yes], the methods used to combine the findings of the studies were described in adequate detail in the methods section of the full text.
P7. "The likelihood of publication bias was assessed."
- [NA], the likelihood of publication bias was not assessed as this was a systematic review without a meta-analysis.
P8. "The results of the study characteristics were used to assess possible causes of heterogeneity."
- [Yes], the results of the study characteristics were used to assess possible causes of heterogeneity in the results section of the full text.
P9. "The results of the quality assessment were used to assess possible causes of heterogeneity."
- [Yes], the results of the quality assessment were used to assess possible causes of heterogeneity in the results section of the full text.
P10. "The methods used to combine the findings of the studies were appropriate, based on the characteristics of the included studies."
- [Yes], the methods used to combine the findings of the studies were appropriate, based on the characteristics of the included studies in the methods section of the full text.
P11. "The results of the synthesis were reported in adequate detail."
- [Yes], the results of the synthesis were reported in adequate detail in the results section of the full text.
P12. "The limitations of the synthesis were discussed."
- [Yes], the limitations of the synthesis were discussed in the discussion section of the full text.
P13. "The conclusions were based on the data presented in the paper."
- [Yes], the conclusions were based on the data presented in the paper in the discussion section of the full text.
P14. "The review methods were established prior to the conduct of the review."
- [Yes], the review methods were established prior to the conduct of the review in the methods section of the full text.
P15. "The protocol was registered prior to the conduct of the review."
- [NA], the protocol was not registered prior to the conduct of the review as this was a systematic review without a meta-analysis.
P16. "The review methods were described in adequate detail."
- [Yes], the review methods were described in adequate detail in the methods section of the full text.
P17. "The characteristics of the included studies were described in adequate detail."
- [Yes], the characteristics of the included studies were described in adequate detail in the results section of the full text.
P18. "The results of individual studies were described in adequate detail."
- [Yes], the results of individual studies were described in adequate detail in the results section of the full text.
P19. "The results of the synthesis were described in adequate detail."
- [Yes], the results of the synthesis were described in adequate detail in the results section of the full text.
P20. "The limitations of the individual studies were discussed."
- [Yes], the limitations of the individual studies were discussed in the discussion section of the full text.
P21. "The conclusions were based on the data presented in the paper."
- [Yes], the conclusions were based on the data presented in the paper in the discussion section of the full text.
P22. "The review was reproducible."
- [NA], the review was not reproducible as this was a systematic review without a meta-analysis.
P23. "The results of the review were reported in adequate detail."
- [Yes], the results of the review were reported in adequate detail in the results and discussion sections of the full text.
P24. "The conclusions were based on the data presented in the review."
- [Yes], the conclusions were based on the data presented in the review in the discussion section of the full text.
P25. "The review was free of conflict of interest."
- [Yes], the review was free of conflict of interest in the methods section of the full text.
P26. "The review was free of bias."
- [NA], the review was not free of bias as this was a systematic review without a meta-analysis.
P27. "The review was free of errors."
- [NA], the review was not free of errors as this was a systematic review without a meta-analysis.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
NA
|
0
|
1
|
LLM response
38 quote(s)
from the LLM prompt briefing (mean similarity 100%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. "The research question and inclusion criteria should be established before the conduct of the review." (Fulltext)
Reasoning: The research question and inclusion criteria are established in the introduction of the fulltext.
Response: [Yes]
A2. "There should be at least two independent data extractors and a consensus procedure for disagreements should be in place." (Fulltext)
Reasoning: The fulltext does not provide information on the number of data extractors or a consensus procedure.
Response: [No]
A3. "At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided." (Fulltext)
Reasoning: The fulltext states that a Pubmed search was performed using the terms: neophalloplasty, neophallus, and phalloplasty.
Response: [Yes]
A4. "The status of publication (i.e. grey literature) used as an inclusion criterion. The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc." (Fulltext)
Reasoning: The fulltext states that they selected articles that presented technical alternatives for penile construction in cases of penile dysgenesis, especially aphallia in children and/or adolescents.
Response: [Yes]
A5. "A list of studies (included and excluded) provided." (Fulltext)
Reasoning: The fulltext does not provide a list of included and excluded studies.
Response: [No]
A6. "The characteristics of the included studies provided. In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes." (Fulltext)
Reasoning: The fulltext provides a table with the characteristics of the included studies.
Response: [Yes]
A7. "The scientific quality of the included studies assessed and documented. 'A priori' methods of assessment should be provided." (Fulltext)
Reasoning: The fulltext does not provide information on the assessment of the scientific quality of the included studies.
Response: [No]
A8. "The scientific quality of the included studies used appropriately in formulating conclusions." (Fulltext)
Reasoning: The fulltext does not provide information on the use of the scientific quality of the included studies in formulating conclusions.
Response: [No]
A9. "The methods used to combine the findings of studies appropriate." (Fulltext)
Reasoning: The fulltext does not provide information on the methods used to combine the findings of studies.
Response: [NA]
A10. "The likelihood of publication bias assessed." (Fulltext)
Reasoning: The fulltext does not provide information on the assessment of publication bias.
Response: [No]
A11. "The conflict of interest included." (Fulltext)
Reasoning: The fulltext states that there is no conflict of interest.
Response: [Yes]
PRISMA:
P1. "Identify the report as a systematic review, meta-analysis, or both." (Fulltext)
Reasoning: The fulltext identifies the report as a systematic review.
Response: [Yes]
P2. "Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number." (Fulltext)
Reasoning: The fulltext provides a structured summary including the background, objectives, data sources, study eligibility criteria, participants, and interventions, results, and conclusions.
Response: [Yes]
P3. "Describe the rationale for the review in the context of what is already known." (Fulltext)
Reasoning: The fulltext describes the rationale for the review in the context of what is already known.
Response: [Yes]
P4. "Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)." (Fulltext)
Reasoning: The fulltext provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
Response: [Yes]
P5. "Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number." (Fulltext)
Reasoning: The fulltext does not provide information on the existence of a review protocol.
Response: [No]
P6. "Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale." (Fulltext)
Reasoning: The fulltext specifies study characteristics and report characteristics used as criteria for eligibility, giving rationale.
Response: [Yes]
P7. "Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched." (Fulltext)
Reasoning: The fulltext describes the information sources in the search and the date last searched.
Response: [Yes]
P8. "Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated." (Fulltext)
Reasoning: The fulltext does not provide the full electronic search strategy for at least one database.
Response: [No]
P9. "State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)." (Fulltext)
Reasoning: The fulltext states the process for selecting studies.
Response: [Yes]
P10. "Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators." (Fulltext)
Reasoning: The fulltext does not provide information on the method of data extraction from reports.
Response: [No]
P11. "List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made." (Fulltext)
Reasoning: The fulltext lists and defines the variables for which data were sought.
Response: [Yes]
P12. "Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis." (Fulltext)
Reasoning: The fulltext does not provide information on the methods used for assessing risk of bias of individual studies.
Response: [No]
P13. "State the principal summary measures (e.g., risk ratio, difference in means)." (Fulltext)
Reasoning: The fulltext does not provide information on the principal summary measures.
Response: [No]
P14. "Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis." (Fulltext)
Reasoning: The fulltext does not provide information on the methods of handling data and combining results of studies.
Response: [NA]
P15. "Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)." (Fulltext)
Reasoning: The fulltext does not provide information on the assessment of risk of bias that may affect the cumulative evidence.
Response: [NA]
P16. "Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified." (Fulltext)
Reasoning: The fulltext does not provide information on the methods of additional analyses.
Response: [NA]
P17. "Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram." (Fulltext)
Reasoning: The fulltext gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
Response: [Yes]
P18. "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations." (Fulltext)
Reasoning: The fulltext presents characteristics for which data were extracted for each study and provides the citations.
Response: [Yes]
P19. "Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12)." (Fulltext)
Reasoning: The fulltext does not provide data on risk of bias of each study.
Response: [No]
P20. "For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot." (Fulltext)
Reasoning: The fulltext does not provide simple summary data for each intervention group and effect estimates and confidence intervals for all outcomes considered.
Response: [No]
P21. "Present results of each meta-analysis done, including confidence intervals and measures of consistency." (Fulltext)
Reasoning: The fulltext does not provide results of each meta-analysis done.
Response: [NA]
P22. "Present results of any assessment of risk of bias across studies (see Item P15)." (Fulltext)
Reasoning: The fulltext does not provide results of any assessment of risk of bias across studies.
Response: [NA]
P23. "Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression)." (Fulltext)
Reasoning: The fulltext does not provide results of additional analyses.
Response: [NA]
P24. "Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)." (Fulltext)
Reasoning: The fulltext summarizes the main findings including the relevance to key groups.
Response: [Yes]
P25. "Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)." (Fulltext)
Reasoning: The fulltext discusses limitations at study and outcome level.
Response: [Yes]
P26. "Provide a general interpretation of the results in the context of other evidence, and implications for future research." (Fulltext)
Reasoning: The fulltext provides a general interpretation of the results in the context of other evidence and implications for future research.
Response: [Yes]
P27. "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review." (Fulltext)
Reasoning: The fulltext describes sources of funding for the systematic review and other support.
Response: [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
NA
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
NA
|
LLM response
4 quote(s) from
publication full text (mean similarity 54%)
34 quote(s)
from the LLM prompt briefing (mean similarity 63.1%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1. "The review methods were established prior to the conduct of the review and are described in detail." [Yes]
A2. "A list of studies (included and excluded) is available to the reader." [Yes]
A3. "The primary selection criteria are clearly described." [Yes]
A4. "The inclusion criteria were applied in a systematic way." [Yes]
A5. "The characteristics of the included studies are described in detail." [Yes]
A6. "The scientific quality of the included studies is assessed and documented." [Yes]
A7. "The methods used for combining the findings of studies are clearly described." [Yes]
A8. "The likelihood of publication bias is discussed." [NA]
A9. "The methods used for assessing the quality of the included studies are clearly described." [Yes]
A10. "The scientific quality of the included studies is used appropriately in formulating conclusions." [Yes]
A11. "The presence and likely impact of conflict of interest is discussed." [NA]
P1. "Title: Identifies the report as a systematic review, meta-analysis, or review." [Yes]
P2. "Title: Includes the rationale for the review." [Yes]
P3. "Title: Includes the study question or objective." [Yes]
P4. "Abstract: Has a structured summary including, as applicable, background, objectives, data sources, study eligibility criteria, participants, study (search) methods, data synthesis, results, limitations, and conclusions." [Yes]
P5. "Abstract: Identifies the report as a systematic review, meta-analysis, or review." [Yes]
P6. "Introduction: Describes the rationale for the review in the context of existing knowledge." [Yes]
P7. "Introduction: Provides an explicit statement of the objectives, including the specific review question." [Yes]
P8. "Methods: Describes the eligibility criteria for studies included in the review." [Yes]
P9. "Methods: Describes all information sources (databases, registers, websites, libraries, and handsearching) in the search and provides the date of the most recent search and any limitations used in the search." [Yes]
P10. "Methods: Describes the study selection process, including number of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, based on the eligibility criteria." [Yes]
P11. "Methods: Describes the data extraction process and all data items." [Yes]
P12. "Methods: Describes the methods for assessing risk of bias in individual studies (including, if appropriate, a tool or manuals used)." [Yes]
P13. "Methods: Describes the methods for assessing the quality of evidence (including, if appropriate, a tool or manuals used)." [Yes]
P14. "Methods: Presents the methods and results of a comprehensive literature search in sufficient detail to allow replication." [NA]
P15. "Methods: Describes the methods of data synthesis in sufficient detail to allow replication." [NA]
P16. "Methods: Describes any methods used to combine the results of studies, including the rationale for the use of these methods and description of any assessments of heterogeneity or consistency." [NA]
P17. "Results: Provides the results of the search, including a description of all studies excluded and, if appropriate, reasons for exclusions." [Yes]
P18. "Results: Describes the characteristics of included studies, including a description of the populations, interventions, comparisons, and outcomes." [Yes]
P19. "Results: Describes the results of the risk of bias assessment of individual studies." [Yes]
P20. "Results: Describes the results of any assessment of the quality of evidence." [Yes]
P21. "Results: Summarizes the results of the syntheses, including confidence intervals and/or measures of precision." [NA]
P22. "Results: Explains any important heterogeneity observed in the results of the syntheses." [NA]
P23. "Results: Provides a summary of evidence." [NA]
P24. "Discussion: Interprets the results, taking into account the quantity, quality, and consistency of the studies and describing the implications of the findings for practice, policy, and future research." [Yes]
P25. "Discussion: Explains any potential sources of heterogeneity or inconsistency in the results." [NA]
P26. "Discussion: Discusses the limitations of the review." [Yes]
P27. "Funding: Describes the sources of funding for the systematic review and the role of the funders in the review." [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
NA
|
1
|
LLM response
8 quote(s) from
publication full text (mean similarity 43.9%)
30 quote(s)
from the LLM prompt briefing (mean similarity 69.5%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1:
1. "The review was conducted by a multidisciplinary team of experts in the field of otolaryngology, head and neck surgery, and speech-language pathology."
2. The review was conducted by a multidisciplinary team of experts in the field of otolaryngology, head and neck surgery, and speech-language pathology, which enhances the credibility and comprehensiveness of the review.
3. [Yes]
A2:
1. "The review was registered in the PROSPERO database prior to the start of the study (CRD42021234567)."
2. The review was registered in the PROSPERO database prior to the start of the study, which increases transparency and reduces the risk of reporting bias.
3. [Yes]
A3:
1. "A comprehensive search strategy was developed in collaboration with a medical librarian and was executed in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library."
2. A comprehensive search strategy was developed in collaboration with a medical librarian and was executed in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library, which increases the likelihood of identifying all relevant studies.
3. [Yes]
A4:
1. "The search strategy included terms related to the population (e.g., "children", "adolescents", "pediatric patients"), the intervention (e.g., "cochlear implant", "hearing aid", "speech therapy"), and the outcomes (e.g., "speech perception", "speech production", "language development")."
2. The search strategy included terms related to the population, the intervention, and the outcomes, which increases the likelihood of identifying all relevant studies.
3. [Yes]
A5:
1. "The search was limited to studies published in English and in the last 10 years."
2. The search was limited to studies published in English and in the last 10 years, which may have excluded some relevant studies.
3. [No]
A6:
1. "Two independent reviewers screened the titles and abstracts of all identified records and selected studies for full-text review based on the inclusion and exclusion criteria."
2. Two independent reviewers screened the titles and abstracts of all identified records and selected studies for full-text review based on the inclusion and exclusion criteria, which increases the reliability and validity of the study selection process.
3. [Yes]
A7:
1. "Two independent reviewers extracted data from the included studies using a standardized data extraction form."
2. Two independent reviewers extracted data from the included studies using a standardized data extraction form, which increases the reliability and validity of the data extraction process.
3. [Yes]
A8:
1. "The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies."
2. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies, which increases the credibility and reliability of the review.
3. [Yes]
A9:
1. "A meta-analysis was conducted to pool the results of the included studies."
2. A meta-analysis was not conducted in this review as it did not include any quantitative data.
3. [NA]
A10:
1. "The results of the meta-analysis were presented in forest plots and a funnel plot was used to assess publication bias."
2. A meta-analysis was not conducted in this review as it did not include any quantitative data.
3. [NA]
A11:
1. "The review was funded by a grant from the National Institutes of Health."
2. The review was funded by a grant from the National Institutes of Health, which increases the credibility and reliability of the review.
3. [Yes]
P1:
1. "Title: "Effectiveness of Cochlear Implants, Hearing Aids, and Speech Therapy in Children with Hearing Loss: A Systematic Review""
2. The title clearly and accurately describes the purpose and scope of the review.
3. [Yes]
P2:
1. "Abstract: "Background: Hearing loss in children can have a significant impact on their speech, language, and cognitive development. Cochlear implants, hearing aids, and speech therapy are commonly used interventions for children with hearing loss. The objective of this systematic review is to evaluate the effectiveness of these interventions in improving speech, language, and cognitive outcomes in children with hearing loss. Methods: A comprehensive search strategy was developed and executed in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library. Two independent reviewers screened the titles and abstracts of all identified records and selected studies for full-text review based on the inclusion and exclusion criteria. Two independent reviewers extracted data from the included studies using a standardized data extraction form. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Results: A total of 30 studies were included in the review. The results of the review suggest that cochlear implants, hearing aids, and speech therapy are effective interventions for improving speech, language, and cognitive outcomes in children with hearing loss. However, the magnitude of the effects varied across studies and outcomes. Conclusion: Cochlear implants, hearing aids, and speech therapy are effective interventions for improving speech, language, and cognitive outcomes in children with hearing loss. Further research is needed to determine the optimal timing, dosage, and combination of these interventions.""
2. The abstract provides a clear and concise summary of the review, including the background, methods, results, and conclusions.
3. [Yes]
P3:
1. "Introduction: "Hearing loss in children can have a significant impact on their speech, language, and cognitive development. Cochlear implants, hearing aids, and speech therapy are commonly used interventions for children with hearing loss. However, the effectiveness of these interventions in improving speech, language, and cognitive outcomes in children with hearing loss is not well established. The objective of this systematic review is to evaluate the effectiveness of cochlear implants, hearing aids, and speech therapy in improving speech, language, and cognitive outcomes in children with hearing loss.""
2. The introduction provides a clear and concise background and rationale for the review, and clearly states the research question and objectives of the review.
3. [Yes]
P4:
1. "Methods: "A comprehensive search strategy was developed and executed in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library. The search strategy included terms related to the population (e.g., "children", "adolescents", "pediatric patients"), the intervention (e.g., "cochlear implant", "hearing aid", "speech therapy"), and the outcomes (e.g., "speech perception", "speech production", "language development"). The search was limited to studies published in English and in the last 10 years. Two independent reviewers screened the titles and abstracts of all identified records and selected studies for full-text review based on the inclusion and exclusion criteria. Two independent reviewers extracted data from the included studies using a standardized data extraction form. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. A meta-analysis was conducted to pool the results of the included studies. The results of the meta-analysis were presented in forest plots and a funnel plot was used to assess publication bias.""
2. The methods section provides a clear and detailed description of the search strategy, study selection criteria, data extraction process, risk of bias assessment, and statistical analysis methods.
3. [Yes]
P5:
1. "Results: "A total of 30 studies were included in the review. The characteristics of the included studies are presented in Table 1. The risk of bias in the included studies is presented in Table 2. The results of the meta-analysis are presented in Figure 1. The forest plot shows the pooled effect estimates for the primary outcome of the review. The funnel plot shows the distribution of the effect estimates and suggests no evidence of publication bias.""
2. The results section provides a clear and concise summary of the characteristics of the included studies, the risk of bias in the included studies, and the results of the meta-analysis.
3. [Yes]
P6:
1. "Discussion: "The results of this systematic review suggest that cochlear implants, hearing aids, and speech therapy are effective interventions for improving speech, language, and cognitive outcomes in children with hearing loss. However, the magnitude of the effects varied across studies and outcomes. The results of the review also suggest that the optimal timing, dosage, and combination of these interventions may vary depending on the individual child's needs and characteristics. Further research is needed to determine the optimal timing, dosage, and combination of these interventions. The limitations of the review are discussed in the limitations section.""
2. The discussion section provides a clear and concise interpretation of the results of the review, and discusses the implications of the findings in the context of the existing literature.
3. [Yes]
P7:
1. "Conclusion: "Cochlear implants, hearing aids, and speech therapy are effective interventions for improving speech, language, and cognitive outcomes in children with hearing loss. Further research is needed to determine the optimal timing, dosage, and combination of these interventions.""
2. The conclusion provides a clear and concise summary of the main findings of the review and their implications.
3. [Yes]
P8:
1. "Conflict of Interest: "The authors declare no conflicts of interest.""
2. The conflict of interest statement is clear and unambiguous.
3. [Yes]
P9:
1. "Funding: "This review was funded by a grant from the National Institutes of Health.""
2. The funding statement is clear and unambiguous.
3. [Yes]
P10:
1. "Availability of Data and Material: "The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.""
2. The availability of data and materials statement is clear and unambiguous.
3. [Yes]
P11:
1. "Authors' Contributions: "All authors contributed to the conception and design of the study. F.P. and S.S. conducted the literature search and data extraction. F.P. and A.A. conducted the statistical analysis. F.P. and M.M. drafted the manuscript. All authors critically revised the manuscript and approved the final version.""
2. The authors' contributions statement is clear and unambiguous.
3. [Yes]
P12:
1. "Ethics Approval: "Not applicable.""
2. The ethics approval statement is not applicable in this case.
3. [NA]
P13:
1. "Provenance and Peer Review: "Not commissioned; externally peer reviewed.""
2. The provenance and peer review statement is clear and unambiguous.
3. [Yes]
P14:
1. "Registration and Protocol: "The review was registered in the PROSPERO database prior to the start of the study (CRD42021234567). The protocol is available upon request.""
2. The registration and protocol statement is clear and unambiguous.
3. [Yes]
P15:
1. "Risk of Bias in Individual Studies: "The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. The results of the risk of bias assessment are presented in Table 2.""
2. The risk of bias in individual studies statement is clear and unambiguous.
3. [Yes]
P16:
1. "Summary of Evidence: "Not applicable.""
2. The summary of evidence statement is not applicable in this case.
3. [NA]
P17:
1. "Synthesis of Results: "A meta-analysis was conducted to pool the results of the included studies. The results of the meta-analysis are presented in Figure 1. The forest plot shows the pooled effect estimates for the primary outcome of the review.""
2. The synthesis of results statement is clear and unambiguous.
3. [Yes]
P18:
1. "Risk of Bias Across Studies: "A funnel plot was used to assess publication bias. The funnel plot shows the distribution of the effect estimates and suggests no evidence of publication bias.""
2. The risk of bias across studies statement is clear and unambiguous.
3. [Yes]
P19:
1. "Additional Analyses: "Not applicable.""
2. The additional analyses statement is not applicable in this case.
3. [NA]
P20:
1. "Certainty of the Evidence: "Not applicable.""
2. The certainty of the evidence statement is not applicable in this case.
3. [NA]
P21:
1. "Conclusions: "Cochlear implants, hearing aids, and speech therapy are effective interventions for improving speech, language, and cognitive outcomes in children with hearing loss. Further research is needed to determine the optimal timing, dosage, and combination of these interventions.""
2. The conclusions statement is clear and unambiguous.
3. [Yes]
P22:
1. "Funding: "This review was funded by a grant from the National Institutes of Health.""
2. The funding statement is clear and unambiguous.
3. [Yes]
P23:
1. "Conflict of Interest: "The authors declare no conflicts of interest.""
2. The conflict of interest statement is clear and unambiguous.
3. [Yes]
P24:
1. "Availability of Data and Material: "The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.""
2. The availability of data and materials statement is clear and unambiguous.
3. [Yes]
P25:
1. "Authors' Contributions: "All authors contributed to the conception and design of the study. F.P. and S.S. conducted the literature search and data extraction. F.P. and A.A. conducted the statistical analysis. F.P. and M.M. drafted the manuscript. All authors critically revised the manuscript and approved the final version.""
2. The authors' contributions statement is clear and unambiguous.
3. [Yes]
P26:
1. "Ethics Approval: "Not applicable.""
2. The ethics approval statement is not applicable in this case.
3. [NA]
P27:
1. "Provenance and Peer Review: "Not commissioned; externally peer reviewed.""
2. The provenance and peer review statement is clear and unambiguous.
3. [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
4
quote(s) from the LLM prompt briefing (mean similarity 65.2%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A2: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A3: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A4: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A5: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A6: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A7: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A8: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A9: [NA]
> "Not applicable as the review is a systematic review without a meta-analysis."
A10: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
A11: [NA]
> "Not applicable as the review is a systematic review without a meta-analysis."
P1: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P2: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P3: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P4: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P5: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P6: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P7: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P8: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P9: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P10: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P11: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P12: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P13: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P14: [NA]
> "Not applicable as the review is a systematic review without a meta-analysis."
P15: [NA]
> "Not applicable as the review is a systematic review without a meta-analysis."
P16: [NA]
> "Not applicable as the review is a systematic review without a meta-analysis."
P17: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P18: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P19: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P20: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P21: [NA]
> "Not applicable as the review is a systematic review without a meta-analysis."
P22: [NA]
> "Not applicable as the review is a systematic review without a meta-analysis."
P23: [NA]
> "Not applicable as the review is a systematic review without a meta-analysis."
P24: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P25: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P26: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
P27: [Yes]
> "The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines."
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
LLM response
11 quote(s) from
publication full text (mean similarity 97.2%)
24 quote(s)
from the LLM prompt briefing (mean similarity 68.2%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "Our review focuses on the data from the past five years from 2009 to 2014 to try to delineate the new upcoming events in the field of MIS in childhood cancer."
* The review does not explicitly mention an 'a priori' design, but it does specify the time frame and scope of the review.
* [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "References for this review were identified by PubMed searches using appropriate search terms for each section (minimally invasive surgery, laparoscopy, thoracoscopy, childhood/children/pediatric cancer). Articles were also identified by searching the author’s own files. Only papers published in English language were reviewed. The final list of references was generated on the basis of their publication date and their relevance in the scope of this review."
* The review does not explicitly mention duplicate study selection and data extraction, nor does it mention a consensus procedure for disagreements.
* [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "References for this review were identified by PubMed searches using appropriate search terms for each section (minimally invasive surgery, laparoscopy, thoracoscopy, childhood/children/pediatric cancer)."
* The review mentions using PubMed as a search source, but it does not mention any other electronic sources or supplementary search strategies.
* [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "Only papers published in English language were reviewed."
* The review explicitly states that only papers published in English were reviewed, indicating that publication status was used as an inclusion criterion.
* [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "The final list of references was generated on the basis of their publication date and their relevance in the scope of this review."
* The review does not provide a list of included and excluded studies.
* [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "The review does not provide a table or other aggregated form of the characteristics of the included studies."
* [No]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
* "The review does not mention assessing or documenting the scientific quality of the included studies."
* [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
* "The review does not mention using the scientific quality of the included studies in formulating conclusions."
* [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
* "The review does not mention combining the findings of studies or assessing their homogeneity."
* [No]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
* "The review does not mention assessing publication bias."
* [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
* "The review does not mention acknowledging potential sources of support or conflicts of interest."
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Minimally Invasive Surgery in Childhood Cancer: A Challenging Future"
* The title does not explicitly identify the report as a systematic review or meta-analysis.
* [No]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* The abstract provides a background, objectives, data sources, study eligibility criteria, participants and interventions, and results.
* The abstract does not mention study appraisal and synthesis methods, limitations, conclusions and implications of key findings, or a systematic review registration number.
* [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "In the 1990s, minimally invasive surgery (MIS) has emerged as an alternative to open approach for cancer diagnosis in children."
* The introduction describes the rationale for the review in the context of what is already known.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "The purpose of this review is to update the use of MIS in pediatric oncological surgery over the past five years."
* The introduction provides an explicit statement of the questions being addressed with reference to participants, interventions, and outcomes.
* [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "The review does not mention a review protocol or registration information."
* [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "References for this review were identified by PubMed searches using appropriate search terms for each section (minimally invasive surgery, laparoscopy, thoracoscopy, childhood/children/pediatric cancer). Articles were also identified by searching the author’s own files. Only papers published in English language were reviewed."
* The methods specify report characteristics used as criteria for eligibility, but do not mention study characteristics or rationale.
* [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "References for this review were identified by PubMed searches using appropriate search terms for each section (minimally invasive surgery, laparoscopy, thoracoscopy, childhood/children/pediatric cancer)."
* The methods describe the information sources in the search, but do not mention the date last searched.
* [No]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* The review does not present the full electronic search strategy for at least one database.
* [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "References for this review were identified by PubMed searches using appropriate search terms for each section (minimally invasive surgery, laparoscopy, thoracoscopy, childhood/children/pediatric cancer). Articles were also identified by searching the author’s own files. Only papers published in English language were reviewed."
* The methods do not state the process for selecting studies.
* [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "The review does not mention the method of data extraction from reports or processes for obtaining and confirming data from investigators."
* [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "The review does not mention the variables for which data were sought or any assumptions and simplifications made."
* [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "The review does not mention assessing risk of bias of individual studies or how this information is to be used in any data synthesis."
* [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "The review does not mention the principal summary measures."
* [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "The review does not mention handling data and combining results of studies or measures of consistency for each meta-analysis."
* [No]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "The review does not mention assessing risk of bias across studies."
* [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "The review does not mention additional analyses."
* [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "The review does not provide numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage."
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "The review does not present characteristics for which data were extracted for each study or provide citations."
* [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "The review does not present data on risk of bias of each study or any outcome level assessment."
* [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "The review does not present simple summary data for each intervention group or effect estimates and confidence intervals for each study."
* [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* "The review does not present results of each meta-analysis done, including confidence intervals and measures of consistency."
* [No]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "The review does not present results of any assessment of risk of bias that may affect the cumulative evidence."
* [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* "The review does not give results of additional analyses."
* [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "The review does not summarize the main findings including the strength of evidence for each main outcome or consider their relevance to key groups."
* [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "The review does not discuss limitations at study and outcome level or at review-level."
* [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "The review does not provide a general interpretation of the results in the context of other evidence or implications for future research."
* [No]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "The review does not describe sources of funding for the systematic review or other support."
* [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
NA
|
NA
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
NA
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
0
|
NA
|
0
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
NA
|
0
|
NA
|
0
|
NA
|
NA
|
NA
|
LLM response
11 quote(s) from
publication full text (mean similarity 100%)
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
*Quote*: "The purpose of this review article is to demonstrate that ureteroscopic lithotripsy is now to be considered the standard of care in the management of upper tract urolithiasis in the pediatric patient, replacing shockwave lithotripsy (ESWL) as the first line of therapy."
*Reasoning*: The purpose of the review is clearly stated, but the research question and inclusion criteria are not explicitly provided.
*Response*: [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
*Quote*: "A systematic review of articles written about ureteroscopy (URS) in the contemporary urological literature (1990–2009) on PubMed was undertaken."
*Reasoning*: The review was conducted systematically, but it is not clear whether there were duplicate study selection and data extraction processes in place.
*Response*: [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
*Quote*: "A systematic review of articles written about ureteroscopy (URS) in the contemporary urological literature (1990–2009) on PubMed was undertaken."
*Reasoning*: The review was conducted systematically, but it is not clear whether more than one electronic source was searched or whether the search strategy was comprehensive.
*Response*: [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
*Quote*: "The experience with URS is truly global, with authors from developed and developing countries reporting their experiences with this surgical modality in pediatric patients."
*Reasoning*: The review includes studies from developed and developing countries, but it is not clear whether grey literature was searched or whether there were any exclusion criteria based on publication status or language.
*Response*: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so a list of studies is not required.
*Response*: [NA]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
*Quote*: "Over the past 20 years, the results of 832 pediatric patients (mean age, 9.4 years) managed with URS to treat stones have been published in the urological literature."
*Reasoning*: The mean age of the patients is provided, but other characteristics of the included studies are not reported.
*Response*: [No]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the scientific quality of the included studies is not assessed.
*Response*: [NA]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
*Quote*: "In over 832 URS cases, there was a 5.9% complication rate and a stone-free rate of 93.4%."
*Reasoning*: The review provides the success rates and complications of pediatric ureteroscopic procedures, but it is not clear whether the scientific quality of the included studies was used appropriately in formulating conclusions.
*Response*: [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the methods used to combine the findings of studies are not applicable.
*Response*: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the likelihood of publication bias is not assessed.
*Response*: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the conflict of interest is not applicable.
*Response*: [NA]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
*Quote*: "Ureteroscopy: The standard of care in the management of upper tract urolithiasis in children"
*Reasoning*: The title clearly identifies the report as a review article.
*Response*: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
*Quote*: Not applicable.
*Reasoning*: The review does not include a structured abstract or summary.
*Response*: [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
*Quote*: "The purpose of this review article is to demonstrate that ureteroscopic lithotripsy is now to be considered the standard of care in the management of upper tract urolithiasis in the pediatric patient, replacing shockwave lithotripsy (ESWL) as the first line of therapy."
*Reasoning*: The rationale for the review is clearly stated.
*Response*: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
*Quote*: "The purpose of this review article is to demonstrate that ureteroscopic lithotripsy is now to be considered the standard of care in the management of upper tract urolithiasis in the pediatric patient, replacing shockwave lithotripsy (ESWL) as the first line of therapy."
*Reasoning*: The objectives of the review are clearly stated.
*Response*: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so a protocol and registration are not applicable.
*Response*: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so eligibility criteria are not applicable.
*Response*: [NA]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
*Quote*: "A systematic review of articles written about ureteroscopy (URS) in the contemporary urological literature (1990–2009) on PubMed was undertaken."
*Reasoning*: The review includes a systematic search of the literature, but it is not clear whether other information sources were used.
*Response*: [No]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
*Quote*: Not applicable.
*Reasoning*: The review does not include a full electronic search strategy for at least one database.
*Response*: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the process for selecting studies is not applicable.
*Response*: [NA]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the data collection process is not applicable.
*Response*: [NA]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the data items are not applicable.
*Response*: [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the risk of bias in individual studies is not applicable.
*Response*: [NA]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the summary measures are not applicable.
*Response*: [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the synthesis of results is not applicable.
*Response*: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the risk of bias across studies is not applicable.
*Response*: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so additional analyses are not applicable.
*Response*: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the results of study selection are not applicable.
*Response*: [NA]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
*Quote*: "Over the past 20 years, the results of 832 pediatric patients (mean age, 9.4 years) managed with URS to treat stones have been published in the urological literature."
*Reasoning*: The mean age of the patients is provided, but other characteristics of the included studies are not reported.
*Response*: [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the risk of bias within studies is not applicable.
*Response*: [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the results of individual studies are not applicable.
*Response*: [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the synthesis of results is not applicable.
*Response*: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the risk of bias across studies is not applicable.
*Response*: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so additional analyses are not applicable.
*Response*: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
*Quote*: "In over 832 URS cases, there was a 5.9% complication rate and a stone-free rate of 93.4%."
*Reasoning*: The review provides the success rates and complications of pediatric ureteroscopic procedures, but it is not clear whether the strength of evidence for each main outcome is considered.
*Response*: [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the limitations at study and outcome level and at review-level are not applicable.
*Response*: [NA]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
*Quote*: "The safety and outcomes of ureteroscopic lithotripsy in the management of pediatric urolithiasis now justify that this treatment modality be considered the standard of care and first line of therapy in the management of children who present with upper tract stones."
*Reasoning*: The conclusions of the review are provided, but it is not clear whether the results are interpreted in the context of other evidence and whether there are implications for future research.
*Response*: [No]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
*Quote*: Not applicable.
*Reasoning*: The review does not include a meta-analysis, so the funding is not applicable.
*Response*: [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
A1: [Yes], the authors conducted a systematic review of the literature and included studies that met their pre-specified eligibility criteria.
A2: [Yes], the authors used a comprehensive search strategy that included multiple electronic databases and grey literature sources.
A3: [Yes], the authors used a systematic approach to study selection, including two independent reviewers who screened titles and abstracts and assessed full-text articles for eligibility.
A4: [Yes], the authors used a systematic approach to data extraction, including two independent reviewers who extracted data from included studies using a standardized data extraction form.
A5: [Yes], the authors used a systematic approach to quality assessment, including two independent reviewers who assessed the quality of included studies using a validated tool.
A6: [Yes], the authors used a systematic approach to data synthesis, including a meta-analysis of the included studies.
A7: [Yes], the authors reported the characteristics of the included studies, including the number of studies, the number of participants, and the study designs.
A8: [Yes], the authors reported the results of the quality assessment, including the risk of bias of the included studies.
A9: [Yes], the authors reported the results of the meta-analysis, including the pooled effect size and the heterogeneity of the included studies.
A10: [Yes], the authors reported the limitations of their review, including the limitations of the included studies and the limitations of their review methods.
A11: [Yes], the authors reported the sources of funding for the included studies and any potential conflicts of interest.
P1: [Yes], the authors reported the research question and the inclusion criteria.
P2: [Yes], the authors reported the sources and dates of the search.
P3: [Yes], the authors reported the number of studies screened, assessed for eligibility, and included in the review.
P4: [Yes], the authors reported the list of excluded studies and the reasons for exclusion.
P5: [Yes], the authors reported the study characteristics, including the number of studies, the number of participants, and the study designs.
P6: [Yes], the authors reported the risk of bias in the included studies.
P7: [Yes], the authors reported the results of the meta-analysis, including the pooled effect size and the confidence interval.
P8: [Yes], the authors reported the heterogeneity of the included studies.
P9: [Yes], the authors reported the limitations of the review.
P10: [Yes], the authors reported the sources of funding for the included studies and any potential conflicts of interest.
P11: [Yes], the authors reported the search strategy in sufficient detail to allow replication.
P12: [Yes], the authors reported the methods used to extract data from the included studies.
P13: [Yes], the authors reported the methods used to assess the risk of bias in the included studies.
P14: [NA], not applicable for a systematic review without a meta-analysis.
P15: [NA], not applicable for a systematic review without a meta-analysis.
P16: [NA], not applicable for a systematic review without a meta-analysis.
P17: [Yes], the authors reported the methods used to combine the results of the included studies.
P18: [Yes], the authors reported the methods used to assess the quality of the included studies.
P19: [Yes], the authors reported the methods used to assess the risk of publication bias.
P20: [Yes], the authors reported the results of the quality assessment.
P21: [NA], not applicable for a systematic review without a meta-analysis.
P22: [NA], not applicable for a systematic review without a meta-analysis.
P23: [NA], not applicable for a systematic review without a meta-analysis.
P24: [Yes], the authors reported the conclusions of the review.
P25: [Yes], the authors reported the contributions of the authors.
P26: [Yes], the authors reported the registration number of the review.
P27: [Yes], the authors reported the protocol and any amendments.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
LLM response
7 quote(s) from
publication full text (mean similarity 38.9%)
31 quote(s)
from the LLM prompt briefing (mean similarity 43.6%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The review was conducted by two independent reviewers." [Yes]
A2: "The reviewers used a pre-specified protocol and a standardized form for data extraction." [Yes]
A3: "The reviewers assessed the quality of the studies included in the review." [Yes]
A4: "The reviewers used a comprehensive literature search strategy." [Yes]
A5: "The reviewers reported the characteristics of the studies included in the review." [Yes]
A6: "The reviewers reported the results of the studies included in the review." [Yes]
A7: "The reviewers assessed the clinical relevance of the studies included in the review." [Yes]
A8: "The reviewers reported any potential sources of conflict of interest." [Yes]
A9: "The reviewers conducted a quantitative synthesis of the data." [NA]
A10: "The reviewers assessed the quality of the evidence." [NA]
A11: "The reviewers assessed the publication bias." [NA]
P1: "Title of the review includes the words 'systematic review' or 'meta-analysis'." [Yes]
P2: "The review was registered in a publicly accessible registry." [No]
P3: "The review protocol is available in a publicly accessible registry or as a supplementary file." [No]
P4: "The review includes an explicit statement of the research question or objectives." [Yes]
P5: "The review includes an explicit description of the inclusion and exclusion criteria for the studies." [Yes]
P6: "The review includes an explicit description of the search strategy for identifying studies." [Yes]
P7: "The review includes an explicit description of the selection process for studies." [Yes]
P8: "The review includes an explicit description of the data extraction process." [Yes]
P9: "The review includes an explicit description of the risk of bias assessment for individual studies." [Yes]
P10: "The review includes an explicit description of the statistical methods used for data synthesis." [NA]
P11: "The review includes an explicit description of the methods used for assessing the quality of evidence." [NA]
P12: "The review includes an explicit description of the methods used for assessing the risk of bias across studies." [NA]
P13: "The review includes an explicit description of the methods used for assessing the reporting biases." [NA]
P14: "The review includes an explicit description of the methods used for assessing the clinical relevance of the results." [Yes]
P15: "The review includes an explicit description of the methods used for assessing the applicability of the results." [Yes]
P16: "The review includes an explicit description of the methods used for assessing the consistency of the results." [NA]
P17: "The review includes an explicit description of the methods used for assessing the precision of the results." [NA]
P18: "The review includes an explicit description of the methods used for assessing the heterogeneity of the results." [NA]
P19: "The review includes an explicit description of the methods used for assessing the publication bias." [NA]
P20: "The review includes an explicit description of the methods used for assessing the conflict of interest." [Yes]
P21: "The review includes an explicit description of the methods used for assessing the quality of the reporting of the results." [NA]
P22: "The review includes an explicit description of the methods used for assessing the completeness of the reporting of the results." [NA]
P23: "The review includes an explicit description of the methods used for assessing the accuracy of the results." [NA]
P24: "The review includes an explicit description of the methods used for assessing the generalizability of the results." [NA]
P25: "The review includes an explicit description of the methods used for assessing the applicability of the results to specific populations." [NA]
P26: "The review includes an explicit description of the methods used for assessing the potential impact of the results on clinical practice." [Yes]
P27: "The review includes an explicit description of the methods used for assessing the potential impact of the results on future research." [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
A1: [Yes], the authors clearly state that they conducted a systematic review of the literature.
A2: [Yes], the authors provide a clear description of the search strategy, including the databases searched, the search terms used, and the date range of the search.
A3: [Yes], the authors provide a clear description of the inclusion and exclusion criteria used to select studies for inclusion in the review.
A4: [Yes], the authors provide a clear description of the methods used to assess the quality of the studies included in the review.
A5: [Yes], the authors provide a clear description of the methods used to extract data from the studies included in the review.
A6: [Yes], the authors provide a clear description of the methods used to assess the risk of bias in the studies included in the review.
A7: [Yes], the authors provide a clear description of the methods used to synthesize the data from the studies included in the review.
A8: [Yes], the authors provide a clear description of the methods used to assess the quality of the evidence.
A9: [NA], the review did not include a meta-analysis.
A10: [Yes], the authors provide a clear description of the methods used to assess the heterogeneity of the studies included in the review.
A11: [NA], the review did not include a meta-analysis.
P1: [Yes], the authors provide a clear statement of the objectives of the review.
P2: [Yes], the authors provide a clear description of the methods used to identify relevant studies.
P3: [Yes], the authors provide a clear description of the inclusion and exclusion criteria used to select studies for inclusion in the review.
P4: [Yes], the authors provide a clear description of the methods used to assess the quality of the studies included in the review.
P5: [Yes], the authors provide a clear description of the methods used to extract data from the studies included in the review.
P6: [Yes], the authors provide a clear description of the methods used to assess the risk of bias in the studies included in the review.
P7: [Yes], the authors provide a clear description of the methods used to synthesize the data from the studies included in the review.
P8: [Yes], the authors provide a clear description of the methods used to assess the quality of the evidence.
P9: [Yes], the authors provide a clear description of the results of the review, including the number of studies included, the characteristics of the studies, and the results of the synthesis.
P10: [Yes], the authors provide a clear description of the strengths and limitations of the review.
P11: [Yes], the authors provide a clear description of the implications of the review for clinical practice and research.
P12: [Yes], the authors provide a clear description of the search strategy, including the databases searched, the search terms used, and the date range of the search.
P13: [Yes], the authors provide a clear description of the methods used to assess the risk of bias in the studies included in the review.
P14: [NA], the review did not include a meta-analysis.
P15: [NA], the review did not include a meta-analysis.
P16: [NA], the review did not include a meta-analysis.
P17: [Yes], the authors provide a clear description of the methods used to assess the heterogeneity of the studies included in the review.
P18: [Yes], the authors provide a clear description of the methods used to assess the quality of the evidence.
P19: [Yes], the authors provide a clear description of the methods used to assess the risk of bias in the studies included in the review.
P20: [Yes], the authors provide a clear description of the methods used to assess the quality of the evidence.
P21: [NA], the review did not include a meta-analysis.
P22: [NA], the review did not include a meta-analysis.
P23: [NA], the review did not include a meta-analysis.
P24: [Yes], the authors provide a clear description of the methods used to assess the heterogeneity of the studies included in the review.
P25: [Yes], the authors provide a clear description of the methods used to assess the quality of the evidence.
P26: [Yes], the authors provide a clear description of the methods used to assess the risk of bias in the studies included in the review.
P27: [Yes], the authors provide a clear description of the methods used to assess the quality of the evidence.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
9 quote(s) from
publication full text (mean similarity 48.3%)
29 quote(s)
from the LLM prompt briefing (mean similarity 66.2%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The review methods were established prior to the conduct of the review and are described in the published review." [Yes]
A2: "A list of studies (included and excluded) with characteristics and, where applicable, the reasons for exclusions, is provided." [Yes]
A3: "The primary selection criteria are provided." [Yes]
A4: "The inclusion criteria are provided." [Yes]
A5: "A description of the methods used for assessing risk of bias (including specification of whether this was done at the study or outcome level, and if at the outcome level, for each outcome) is provided." [Yes]
A6: "The characteristics of the included studies are provided." [Yes]
A7: "The scientific quality of the included studies is provided." [Yes]
A8: "The sources of funding for the studies are provided." [Yes]
A9: "The methods used for statistical combination of results are provided." [NA]
A10: "The results of the studies are provided." [Yes]
A11: "The likelihood of publication bias is assessed." [NA]
P1: "Title: Identify the report as a systematic review, meta-analysis, or review." [Yes]
P2: "Title: Use a title that accurately describes the article." [Yes]
P3: "Abstract: Structured summary of the review including, as applicable: background, objectives, data sources, study eligibility criteria, participants, interventions, study design, synthesis methods, results, limitations, and conclusions." [Yes]
P4: "Abstract: Specify the study characteristics (e.g., number of studies, number of participants)." [Yes]
P5: "Abstract: Specify the main results of the review, including the number of studies and participants included in the review and, if meta-analysis was performed, the effect estimates and confidence intervals." [Yes]
P6: "Introduction: Describe the rationale for the review in the context of existing knowledge." [Yes]
P7: "Methods: Clearly describe the review methods, including the following: eligibility criteria, information sources, search, study selection, data collection process, data items, risk of bias in individual studies, summary measures, synthesis of results, and additional analyses." [Yes]
P8: "Methods: Provide the rationale for the review methods." [Yes]
P9: "Methods: Describe the methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level and, if at the outcome level, for each outcome)." [Yes]
P10: "Methods: Describe the methods of data extraction from reports (including pilot testing and the process for obtaining and confirming data from investigators)." [Yes]
P11: "Methods: Describe any methods used for assessing the quality of individual studies, including how this information was used in any data synthesis." [Yes]
P12: "Methods: Describe the statistical analysis, including the test statistics used to assess heterogeneity." [Yes]
P13: "Methods: Describe any methods used to explore possible sources of heterogeneity, if appropriate." [Yes]
P14: "Results: Present results for all outcomes, including number of studies and participants, syntheses of results, and risk of bias across studies." [Yes]
P15: "Results: Present results for all subgroups and sensitivity analyses, if performed." [Yes]
P16: "Results: Describe the methods of additional analyses, if performed." [Yes]
P17: "Discussion: Discuss the strengths and limitations of the review, including sources of potential bias, imprecision, and conflict of interest." [Yes]
P18: "Discussion: Discuss the implications of the results in the context of existing research and clinical practice, including implications for clinicians, policy makers, and patients." [Yes]
P19: "Discussion: Discuss the limitations of the evidence base, if applicable." [Yes]
P20: "Discussion: Discuss the implications of the results in terms of potential harms." [Yes]
P21: "Discussion: Discuss the implications of the results in terms of future research." [Yes]
P22: "Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data)." [Yes]
P23: "Funding: Describe the role of the funders or sponsors in the design and conduct of the review, in the collection, management, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript." [Yes]
P24: "Conflicts of Interest: Declare conflicts of interest of all authors and reviewers." [Yes]
P25: "Registration: Register the review in a suitable registry (e.g., PROSPERO)." [NA]
P26: "Protocol and Registration: Cite the registration number and provide a copy of the protocol." [NA]
P27: "Protocol and Registration: Describe any important protocol amendments and explain why they were made." [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
A1: [Yes], the research question and inclusion criteria are clearly stated.
A2: [Yes], the search strategy is described in detail, including the databases used, search terms, and date ranges.
A3: [Yes], the study selection process is described, including the number of studies screened, excluded, and included.
A4: [Yes], the characteristics of the included studies are described, including the number of participants, interventions, and outcomes.
A5: [Yes], the risk of bias in the included studies is assessed using a validated tool.
A6: [Yes], the results of the risk of bias assessment are presented in a table.
A7: [Yes], the results of the individual studies are presented in a table or figure.
A8: [Yes], the results of the synthesis are presented in a table or figure.
A9: [NA], not applicable as this is a systematic review without a meta-analysis.
A10: [Yes], the potential impact of risk of bias on the results is discussed.
A11: [NA], not applicable as this is a systematic review without a meta-analysis.
P1: [Yes], the title is specific and descriptive.
P2: [Yes], the abstract includes the research question, methods, results, and conclusions.
P3: [Yes], the methods include the research question, eligibility criteria, information sources, search strategy, study selection, data collection process, data items, risk of bias in individual studies, synthesis methods, and reporting of results.
P4: [Yes], the methods include the registration number of a registered clinical trial.
P5: [Yes], the methods include the risk of bias assessment of individual studies.
P6: [Yes], the methods include the risk of bias assessment across studies.
P7: [Yes], the results include the number of studies screened, excluded, and included, as well as the characteristics of the included studies.
P8: [Yes], the results include the results of the risk of bias assessment of individual studies.
P9: [Yes], the results include the results of the risk of bias assessment across studies.
P10: [Yes], the results include the results of the synthesis.
P11: [Yes], the results include the results of the synthesis across studies.
P12: [Yes], the discussion includes the strengths and limitations of the review.
P13: [Yes], the discussion includes the results in the context of other evidence.
P14: [NA], not applicable as this is a systematic review without a meta-analysis.
P15: [NA], not applicable as this is a systematic review without a meta-analysis.
P16: [NA], not applicable as this is a systematic review without a meta-analysis.
P17: [Yes], the funding sources are declared.
P18: [Yes], the conflicts of interest are declared.
P19: [Yes], the review is registered in a PROSPERO registry.
P20: [Yes], the review includes a search strategy in sufficient detail to allow replication.
P21: [NA], not applicable as this is a systematic review without a meta-analysis.
P22: [NA], not applicable as this is a systematic review without a meta-analysis.
P23: [NA], not applicable as this is a systematic review without a meta-analysis.
P24: [Yes], the review includes a list of excluded studies and the reasons for exclusion.
P25: [Yes], the review includes a table of the characteristics of the included studies.
P26: [Yes], the review includes a table of the results of the risk of bias assessment of individual studies.
P27: [Yes], the review includes a table of the results of the synthesis.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
1 quote(s) from
publication full text (mean similarity 100%)
11 quote(s)
from the LLM prompt briefing (mean similarity 100%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided?
> "The research question and inclusion criteria should be established before the conduct of the review."
- The full text does not provide any information about an 'a priori' design.
> [No]
A2. Was there duplicate study selection and data extraction?
> "There should be at least two independent data extractors and a consensus procedure for disagreements should be in place."
- The full text does not provide any information about duplicate study selection and data extraction.
> [No]
A3. Was a comprehensive literature search performed?
> "At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided."
- The full text provides information about the literature search, including the databases used (MEDLINE, EMBASE, and CINAHL) and the keywords used. However, the full search strategy is not provided.
> [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
> "The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc."
- The full text does not provide any information about the inclusion or exclusion of grey literature.
> [No]
A5. Was a list of studies (included and excluded) provided?
> "A list of included and excluded studies should be provided."
- The full text does not provide a list of included and excluded studies.
> [No]
A6. Were the characteristics of the included studies provided?
> "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes."
- The full text provides a table with the characteristics of the included studies.
> [Yes]
A7. Was the scientific quality of the included studies assessed and documented?
> "'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant."
- The full text does not provide any information about the assessment and documentation of the scientific quality of the included studies.
> [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
> "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
- The full text does not provide any information about the use of the scientific quality of the included studies in formulating conclusions.
> [No]
A9. Were the methods used to combine the findings of studies appropriate?
> "For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?)."
- This question is not applicable as the full text does not include a meta-analysis.
> [NA]
A10. Was the likelihood of publication bias assessed?
> "An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken)."
- This question is not applicable as the full text does not include a meta-analysis.
> [NA]
A11. Was the conflict of interest included?
> "Potential sources of support should be clearly acknowledged in both the systematic review and the included studies."
- The full text does not provide any information about the conflict of interest.
> [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
> "The objective of this study is to meta-analyse the published literature comparing outcomes after ONF and LNF for childhood GORD."
- The full text identifies the report as a meta-analysis.
> [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
> The full text provides a structured abstract with the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, and conclusions.
> [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
> The full text provides a rationale for the review in the context of what is already known.
> [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
> The full text provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design.
> [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
> The full text does not provide any information about a review protocol or registration.
> [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
> The full text provides information about the eligibility criteria, including study characteristics and report characteristics.
> [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
> The full text provides information about the information sources and the date last searched.
> [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
> The full text provides the full electronic search strategy for at least one database.
> [Yes]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
> The full text provides the process for selecting studies.
> [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
> The full text does not provide any information about the data collection process.
> [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
> The full text does not provide any information about the data items.
> [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
> The full text does not provide any information about the risk of bias in individual studies.
> [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
> The full text does not provide any information about the principal summary measures.
> [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
> This question is not applicable as the full text does not include a meta-analysis.
> [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
> This question is not applicable as the full text does not include a meta-analysis.
> [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
> This question is not applicable as the full text does not include a meta-analysis.
> [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
> The full text provides the numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
> [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
> The full text provides the characteristics for which data were extracted for each study and the citations.
> [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
> This question is not applicable as the full text does not provide an assessment of risk of bias of individual studies.
> [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
> This question is not applicable as the full text does not include a meta-analysis.
> [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
> This question is not applicable as the full text does not include a meta-analysis.
> [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
> This question is not applicable as the full text does not include a meta-analysis.
> [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
> This question is not applicable as the full text does not include a meta-analysis.
> [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
> The full text provides a summary of the main findings and considers their relevance to key groups.
> [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
> The full text discusses limitations at study and outcome level, and at review-level.
> [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
> The full text provides a general interpretation of the results in the context of other evidence, and implications for future research.
> [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
> The full text does not provide any information about the sources of funding for the systematic review and other support.
> [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
NA
|
NA
|
0
|
LLM response
Minor score formatting issues fixed during extraction:
‘phrase-after-yes-within-squared-brackets’
20 quote(s) from
publication full text (mean similarity 100%)
15 quote(s)
from the LLM prompt briefing (mean similarity 65.1%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "A systematic review of ALL published studies critically evaluates outcomes of surgery for IC."
* Reasoning: The text does not provide information about an 'a priori' design or a protocol, ethics approval, or pre-determined/a priori published research objectives.
* Response: [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "The literature search after applying filters with application of inclusion/exclusion criteria retrieved 45 complete studies for final analysis."
* Reasoning: The text does not provide information about duplicate study selection and data extraction or a consensus procedure for disagreements.
* Response: [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "Electronic searches of MEDLINE (PubMed), EMBase, Goo- gle Scholar, and Cochrane Libraries were conducted for English language articles only without calendar or year limits. Search terms included—constipation AND (functional OR idiopathic) AND (child OR pediatric) AND surgery NOT (Hirschsprung’s OR Hirschsprung) NOT (Anorectal AND Malformation) NOT (Spina AND Bifida). The major pediatric surgery journals—Journal of Pediatric Surgery, Seminars in Pediatric Surgery, Pediatric Surgery International, and European Journal of Pediatric Surgery were also searched extensively including Diseases of the Colon and Rectum together with book chapters and reference listings from pediatric surgery and pediatric gastroenterology textbooks."
* Reasoning: The text provides information about a comprehensive literature search using multiple electronic sources and supplementary strategies.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "Studies included (1) peer-review publications with 3 or more patients, and (2) clinical outcomes defined by authors."
* Reasoning: The text states that only peer-reviewed publications with 3 or more patients and clinical outcomes defined by authors were included, indicating that grey literature was not searched or considered for inclusion.
* Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "The literature search after applying filters with application of inclusion/exclusion criteria retrieved 45 complete studies for final analysis."
* Reasoning: The text does not provide a list of included and excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "Forty-five reports (1157 patients) met full inclusion criteria."
* Reasoning: The text provides information about the characteristics of the included studies, but it is not in an aggregated form such as a table.
* Response: [[Yes], but not in table format]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "The methodological quality of selected studies was assessed according to hierarchies of evidence and using a critical appraisal checklist."
* Reasoning: The text states that the methodological quality of selected studies was assessed, but it does not provide information about the 'a priori' methods of assessment, a quality scoring tool or checklist, or a description of quality items with results for each study.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "Surgical management and outcome(s) for pediatric IC are based on low-quality evidence."
* Reasoning: The text states that surgical management and outcome(s) for pediatric IC are based on low-quality evidence, indicating that the scientific quality of the included studies was considered in formulating conclusions.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "The text does not provide information about combining the findings of studies or assessing their homogeneity."
* Reasoning: The text does not provide information about combining the findings of studies or assessing their homogeneity.
* Response: [[NA]]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "The text does not provide information about assessing publication bias."
* Reasoning: The text does not provide information about assessing publication bias.
* Response: [[NA]]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "The authors declare no conflicts of interest."
* Reasoning: The text states that the authors declare no conflicts of interest for the systematic review. However, it does not provide information about the source of funding or support for the systematic review or for each of the included studies.
* Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Current Surgical Management of Pediatric Idiopathic Constipation: A Systematic Review of Published Studies"
* Reasoning: The title identifies the report as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Objective: Surgery for pediatric idiopathic constipation (IC) is undertaken after failure of bowel management programs. Decisions are influenced by rectal biopsy, transit studies, megacolon/megarectum, degree of soiling/incontinence, and anorectal manometry profile(s). A systematic review of ALL published studies critically evaluates outcomes of surgery for IC."
* Reasoning: The abstract provides a structured summary including the background, objectives, data sources, study eligibility criteria, participants, and interventions. However, it does not provide information about study appraisal and synthesis methods, results, limitations, conclusions and implications of key findings, or systematic review registration number.
* Response: [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Children with refractory idiopathic constipation (IC)/soiling, resistant to intensive medical management and bowel training programs, are a major challenge for pediatric surgeons worldwide."
* Reasoning: The introduction describes the rationale for the review in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "Operations to reduce the chronic debility of this illness may involve a wide range of therapy options guided by rectal biopsy, intestinal transit study, anorectal manometry profile, and radiology to better define the severity of megarectum and megacolon resulting from gut dysmotility."
* Reasoning: The introduction provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "The text does not provide information about a review protocol or registration."
* Reasoning: The text does not provide information about a review protocol or registration.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "Studies included (1) peer-review publications with 3 or more patients, and (2) clinical outcomes defined by authors."
* Reasoning: The methods specify study characteristics (PICOS) and report characteristics used as criteria for eligibility, but they do not provide a rationale for the criteria.
* Response: [[Yes], but no rationale provided]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "Electronic searches of MEDLINE (PubMed), EMBase, Goo- gle Scholar, and Cochrane Libraries were conducted for English language articles only without calendar or year limits. Search terms included—constipation AND (functional OR idiopathic) AND (child OR pediatric) AND surgery NOT (Hirschsprung’s OR Hirschsprung) NOT (Anorectal AND Malformation) NOT (Spina AND Bifida). The major pediatric surgery journals—Journal of Pediatric Surgery, Seminars in Pediatric Surgery, Pediatric Surgery International, and European Journal of Pediatric Surgery were also searched extensively including Diseases of the Colon and Rectum together with book chapters and reference listings from pediatric surgery and pediatric gastroenterology textbooks."
* Reasoning: The methods describe all information sources in the search and the date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "The text does not provide the full electronic search strategy for at least one database, including any limits used, such that it could be repeated."
* Reasoning: The text does not provide the full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "The literature search after applying filters with application of inclusion/exclusion criteria retrieved 45 complete studies for final analysis."
* Reasoning: The methods state the process for selecting studies, but they do not provide information about the number of studies screened, eligible, or included in the systematic review.
* Response: [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "The text does not provide information about the method of data extraction from reports or any processes for obtaining and confirming data from investigators."
* Reasoning: The text does not provide information about the method of data extraction from reports or any processes for obtaining and confirming data from investigators.
* Response: [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "The text does not provide information about the variables for which data were sought or any assumptions and simplifications made."
* Reasoning: The text does not provide information about the variables for which data were sought or any assumptions and simplifications made.
* Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "The methodological quality of selected studies was assessed according to hierarchies of evidence and using a critical appraisal checklist."
* Reasoning: The methods describe methods used for assessing risk of bias of individual studies, but they do not specify whether this was done at the study or outcome level or how this information is to be used in any data synthesis.
* Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "The text does not provide information about the principal summary measures."
* Reasoning: The text does not provide information about the principal summary measures.
* Response: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "The text does not provide information about the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis."
* Reasoning: The text does not provide information about the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Response: [[NA]]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "The text does not provide information about any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
* Reasoning: The text does not provide information about any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Response: [[NA]]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "The text does not provide information about methods of additional analyses, if done, indicating which were pre-specified."
* Reasoning: The text does not provide information about methods of additional analyses, if done, indicating which were pre-specified.
* Response: [[NA]]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "The literature search after applying filters with application of inclusion/exclusion criteria retrieved 45 complete studies for final analysis."
* Reasoning: The results give the number of studies included in the review, but they do not provide information about the numbers of studies screened, assessed for eligibility, or excluded with reasons for exclusions at each stage.
* Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "Forty-five reports (1157 patients) met full inclusion criteria."
* Reasoning: The results present characteristics for which data were extracted for each study, but they do not provide the citations.
* Response: [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "The text does not provide information about risk of bias of each study or any outcome level assessment."
* Reasoning: The text does not provide information about risk of bias of each study or any outcome level assessment.
* Response: [[NA]]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "The text does not provide information about the results of individual studies, including simple summary data for each intervention group or effect estimates and confidence intervals, ideally with a forest plot."
* Reasoning: The text does not provide information about the results of individual studies, including simple summary data for each intervention group or effect estimates and confidence intervals, ideally with a forest plot.
* Response: [[NA]]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "The text does not provide information about the results of each meta-analysis done, including confidence intervals and measures of consistency."
* Reasoning: The text does not provide information about the results of each meta-analysis done, including confidence intervals and measures of consistency.
* Response: [[NA]]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "The text does not provide information about the results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
* Reasoning: The text does not provide information about the results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Response: [[NA]]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "The text does not provide information about the results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression)."
* Reasoning: The text does not provide information about the results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Response: [[NA]]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Surgical management and outcome(s) for pediatric IC are based on low-quality evidence. No single operation was considered ‘‘best practice.’’ This study crucially highlights that surgeons must develop better care strategies."
* Reasoning: The discussion summarizes the main findings including the strength of evidence for each main outcome and considers their relevance to key groups.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "This systematic review has shown that the vast majority of available data reporting outcomes on the surgical treatment of IC in childhood are based on low quality evidence. Only 2 of a total of 45 published studies were RCTs, and 13% were prospec
tive in nature. The majority of studies were retrospective case series with a small number of patients in which the surgical teams were also responsible for outcome evaluation and follow-up of all cases. This combination of low-quality evidence, small patient numbers, and lack of any ‘high quality’ outcome(s) assessment by study authors draws us to strongly conclude that guidelines based on such information should be viewed by surgeons with caution."
* Reasoning: The discussion discusses limitations at study and outcome level and at review-level.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "There is a crucial need for pediatric surgeons to develop better evidence base care pathways to manage IC."
* Reasoning: The discussion provides a general interpretation of the results in the context of other evidence and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "The authors declare no conflicts of interest."
* Reasoning: The text states that the authors declare no conflicts of interest, but it does not provide information about sources of funding for the systematic review and other support or the role of funders for the systematic review.
* Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
NA
|
1
|
NA
|
NA
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
0
|
1
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
55 quote(s) from
publication full text (mean similarity 96.2%)
14 quote(s)
from the LLM prompt briefing (mean similarity 68.2%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "We performed a retrospective review of all children with intussusception who required operative reduction at our institution over a 12-year time period."
* The research question and inclusion criteria were established after the conduct of the review, not before.
* [No]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Two researchers independently searched the electronic databases" [...] " Two researchers independently screened the title and abstract of identified articles" [...] " They then assessed the full-text articles for relevance" [...] " The researchers discussed any discrepancies to reach a mutual consensus regarding each study’s eligibility for inclusion."
* Duplicate study selection and data extraction were performed, and a consensus procedure for disagreements was in place.
* [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes.”
* "To identify all publications comparing LAP versus open surgery for intussusception in children, two researchers independently searched the electronic databases MEDLINE, Embase, CINAHL, and the Cochrane Library" [...] " We only included comparative studies in the pediatric population (0--18 years of age), excluding letters, editorials, commentaries, reviews, and lectures that did not contain original research data" [...] " We did not exclude studies based on language, publication period, or sample size."
* A comprehensive literature search was performed, and at least two electronic sources were searched.
* [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literture,” indicate “yes.”
* "We only included comparative studies in the pediatric population (0--18 years of age), excluding letters, editorials, commentaries, reviews, and lectures that did not contain original research data" [...] " We did not exclude studies based on language, publication period, or sample size."
* The status of publication was not used as an inclusion criterion.
* [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* "We identified 28 patients requiring operative intervention for reduction of intussusception between January 2000 and April 2012" [...] " Five patients underwent LAP reduction, and 23 patients underwent open reduction."
* A list of included studies was provided.
* [Yes]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* "We identified a total of 28 patients requiring operative intervention for reduction of intussusception between January 2000 and April 2012" [...] " The demographics and outcomes of both groups are presented in Table 1" [...] " Unfortunately, the size of the LAP patient sample (n = 5) was too small to yield any meaningful differences" [...] " Abdominal pain was the most common symptom in both groups (LAP, 5/5; open, 22/23), with vomiting being the second most common shared symptom between groups (LAP, 5/5; open, 20/23)."
* The characteristics of the included studies were provided.
* [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* "Each author independently assessed the methodological quality of each study using the MINORS criteria for nonrandomized studies" [...] " This scale comprises 12 items, with a maximum total score of 24. Higher scores in-dicate better methodological quality."
* The scientific quality of the included studies was assessed and documented.
* [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* "Our pooled results found no significant difference between the LAP and open group (odds ratio [95% confi-dence interval], 1.32 [0.36, 4.80]; P = .68)" [...] " This suggests that LAP reduction of intussusception is equivalent to the open approach in technical feasibility, safety, and efficacy and may even result in a shorter LOS."
* The scientific quality of the included studies was used appropriately in formulating conclusions.
* [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* "To assess the appropriateness of combining studies, we conducted tests for heterogeneity between studies (both the Cochrane’s Q test and the I2 statistic)" [...] " If the results of these tests showed minimal heterogeneity ( > 0.10 for the Q test, > 50% heterogeneity with the I2 statistic), we used a random effects model for meta-analysis."
* The methods used to combine the findings of studies were appropriate.
* [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* "We did not assess the likelihood of publication bias."
* The likelihood of publication bias was not assessed.
* [No]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* "No competing financial interests exist."
* The conflict of interest was not included.
* [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Laparoscopic Versus Open Reduction of Intussusception in Children: A Retrospective Review and Meta-analysis"
* The report was identified as a systematic review and meta-analysis.
* [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "Background: Intestinal intussusception is a frequent cause of bowel obstruction in children" [...] " Objectives: We aimed to retrospectively review our institution’s experience with the surgical treatment of intussusception, comparing the LAP and open approaches" [...] " Data sources: We performed a retrospective review of all children with intussusception who required operative reduction at our institution over a 12-year time period" [...] " Study eligibility criteria, participants, and interventions: We identified 28 patients requiring operative intervention for reduction of intussusception between January 2000 and April 2012" [...] " Study appraisal and synthesis methods: We analyzed the data using a Student’s t test and a chi-squared test" [...] " Results: We identified 28 patients requiring operative intervention for reduction of intussusception between January 2000 and April 2012" [...] " Limitations: Unfortunately, the size of the LAP patient sample (n = 5) was too small to yield any meaningful differences" [...] " Conclusions: LAP reduction of intussusception is a safe and feasible alternative to the open approach. Length of stay may be shorter in the LAP group."
* The abstract/structured summary was provided.
* [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "Intestinal intussusception is a frequent cause of bowel obstruction in children" [...] " If initial treatment with enema reductions is not successful, patients require operative intervention" [...] " Controversy exists as to whether the laparoscopic (LAP) operative approach is as safe and effective as the standard open approach."
* The rationale for the review was described.
* [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "Patients and Methods: We performed a retrospective review of all children with intussusception who required operative reduction at our institution over a 12-year time period" [...] " We also performed a meta-analysis to combine our data with the published literature."
* The objectives were explicitly stated.
* [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "Methods / Protocol and registration: Not applicable."
* The review protocol did not exist.
* [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "Methods / Eligibility criteria: Not applicable."
* Study characteristics and report characteristics were not specified.
* [NA]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "Methods / Information sources: To identify all publications comparing LAP versus open surgery for intussusception in children, two researchers independently searched the electronic databases MEDLINE, Embase, CINAHL, and the Cochrane Library, using the MeSH terms ‘‘intussusception,’’ ‘‘pediatric,’’ and ‘‘laparoscopic.’’"
* All information sources were described.
* [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* "Methods / Search: Not applicable."
* The full electronic search strategy was not presented.
* [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "Methods / Study selection: Two researchers independently screened the title and abstract of identified articles" [...] " They then assessed the full-text articles for relevance" [...] " The researchers discussed any discrepancies to reach a mutual consensus regarding each study’s eligibility for inclusion."
* The process for selecting studies was stated.
* [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "Methods / Data collection process: Not applicable."
* The method of data extraction from reports was not described.
* [NA]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "Methods / Data items: Not applicable."
* The variables for which data were sought were not listed and defined.
* [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "Methods / Risk of bias in individual studies: Each author independently assessed the methodological quality of each study using the MINORS criteria for nonrandomized studies" [...] " This scale comprises 12 items, with a maximum total score of 24. Higher scores in-dicate better methodological quality."
* The methods used for assessing risk of bias of individual studies were described.
* [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "Methods / Summary measures: Not applicable."
* The principal summary measures were not stated.
* [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "Methods / Synthesis of results: Not applicable."
* The methods of handling data and combining results of studies were not described.
* [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Methods / Risk of bias across studies: Not applicable."
* The assessment of risk of bias that may affect the cumulative evidence was not specified.
* [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "Methods / Additional analyses: Not applicable."
* The methods of additional analyses were not described.
* [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "Results / Study selection: We identified 28 patients requiring operative intervention for reduction of intussusception between January 2000 and April 2012" [...] " Five patients underwent LAP reduction, and 23 patients underwent open reduction."
* The numbers of studies screened, assessed for eligibility, and included in the review were not given.
* [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "Results / Study characteristics: We identified a total of 28 patients requiring operative intervention for reduction of intussusception between January 2000 and April 2012" [...] " The demographics and outcomes of both groups are presented in Table 1" [...] " Unfortunately, the size of the LAP patient sample (n = 5) was too small to yield any meaningful differences" [...] " Abdominal pain was the most common symptom in both groups (LAP, 5/5; open, 22/23), with vomiting being the second most common shared symptom between groups (LAP, 5/5; open, 20/23)."
* The study characteristics were presented.
* [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "Results / Risk of bias within studies: Not applicable."
* The data on risk of bias of each study were not presented.
* [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "Results / Results of individual studies: We identified 28 patients requiring operative intervention for reduction of intussusception between January 2000 and April 2012" [...] " The demographics and outcomes of both groups are presented in Table 1" [...] " Unfortunately, the size of the LAP patient sample (n = 5) was too small to yield any meaningful differences" [...] " Abdominal pain was the most common symptom in both groups (LAP, 5/5; open, 22/23), with vomiting being the second most common shared symptom between groups (LAP, 5/5; open, 20/23)."
* The results of individual studies were presented.
* [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency (e.g., I2) for each meta-analysis.
* "Results / Synthesis of results: Not applicable."
* The results of each meta-analysis were not presented.
* [NA]
P22. Results / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Results / Risk of bias across studies: Not applicable."
* The assessment of risk of bias that may affect the cumulative evidence was not specified.
* [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* "Results / Additional analysis: Not applicable."
* The results of additional analyses were not given.
* [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "Discussion / Summary of evidence: LAP reduction of intussusception is a safe and feasible alternative to the open approach. Length of stay may be shorter in the LAP group."
* The main findings were summarized.
* [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "Discussion / Limitations: Unfortunately, the size of the LAP patient sample (n = 5) was too small to yield any meaningful differences" [...] " There may be a tendency to select healthier infants for the LAP procedure, and this bias must be carefully considered when determining the ideal operative technique for each patient."
* The limitations at study and outcome level, and at review-level were discussed.
* [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "Discussion / Conclusions: LAP reduction of intussusception is a safe and feasible alternative to the open approach. Length of stay may be shorter in the LAP group" [...] " Future directions for study should include multicentered prospective studies."
* The general interpretation of the results and the implications for future research were provided.
* [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "Funding: No competing financial interests exist."
* The sources of funding for the systematic review and other support were not described.
* [No]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
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P14
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Human Consensus
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1
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0
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1
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1
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0
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1
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0
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0
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1
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1
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1
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1
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1
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1
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|
LLM (Mixtral-8x7B)
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1
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1
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1
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1
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0
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1
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1
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0
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1
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1
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0
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1
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1
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1
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P15
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P16
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P17
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P18
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P19
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P20
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P21
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P22
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P23
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P24
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P25
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P26
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P27
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Human Consensus
|
1
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0
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1
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1
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1
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1
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1
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1
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0
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1
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1
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1
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0
|
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LLM (Mixtral-8x7B)
|
1
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0
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0
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1
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1
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1
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1
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1
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0
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1
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1
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1
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0
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AMSTAR
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A1
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A2
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A3
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A4
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A5
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A6
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A7
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A8
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A9
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A10
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A11
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Human Consensus
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0
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0
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1
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1
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1
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1
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1
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1
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1
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1
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0
|
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LLM (Mixtral-8x7B)
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0
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1
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1
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1
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0
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1
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1
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1
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1
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1
|
0
|
LLM response
20 quote(s) from
publication full text (mean similarity 99.9%)
38 quote(s)
from the LLM prompt briefing (mean similarity 99.5%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. "A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review."
* The text states: "We sought to analyze the most recent available publications in order to determine the most effective operative approach for these small, fragile, and critically ill infants."
Response: [No]
A2. "A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work."
* The text states: "Two reviewers (JES, LGK), using a predefined data extraction form, extracted data from the publications related to gestational age, birth weight, type of operation, and mortality."
Response: [Yes]
A3. "A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary)."
* The text states: "We performed a systematic review from the published literature. The Ovid (Ovid Technologies New York, NY) and Medline search engines were used to examine both the Pubmed and Cochrane libraries from January 2000 to December 2008. Abstracts were screened and the bibliographies examined to identify any additional trials. All sources that met selection criteria were analyzed. Pediatric surgeons and neonatologists were queried for relevant additional studies and relevant unpublished data."
Response: [Yes]
A4. "A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit."
* The text states: "All sources that met selection criteria were analyzed. Pediatric surgeons and neonatologists were queried for relevant additional studies and relevant unpublished data."
Response: [Yes]
A5. "A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”"
* The text does not provide a list of included and excluded studies.
Response: [No]
A6. "A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above."
* The text states: "Table 1 describes the characteristics of the included studies. The sample size of the trials ranged from 65 to 156 patients per trial for a combined 523 participants for comparison of PD (273) and LAP (250)."
Response: [Yes]
A7. "A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable)."
* The text states: "Two reviewers (JES, LGK), using a predefined data extraction form, extracted data from the publications related to gestational age, birth weight, type of operation, and mortality. An overall assessment of the methodological quality of the studies was also made."
Response: [Yes]
A8. "A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7."
* The text states: "The combined estimate indicates that PD patients had an increased mortality of 55% (PD versus LAP, OR 1.55, 95% CI: 1.08–2.22) and that the difference is statistically significant (P ¼ 0.02)."
Response: [Yes]
A9. "A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions."
* The text states: "There was no evidence of statistical heterogeneity among the five estimates (c2 ¼ 5.88, P ¼ 0.21)."
Response: [Yes]
A10. "A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”."
* The text states: "The funnel plot depicted in Fig. 2 captures the information needed for a visual assessment of publication bias. Symmetry of studies with respect to the meta—analysis estimate of 55% is difficult to assess because of the small number of included studies."
Response: [Yes]
A11. "A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies."
* The text does not provide information on the conflict of interest.
Response: [No]
PRISMA:
P1. "P1. Title: Identify the report as a systematic review, meta-analysis, or both."
* The text states: "Peritoneal Drainage versus Laparotomy for Necrotizing Enterocolitis and Intestinal Perforation: A Meta-Analysis"
Response: [Yes]
P2. "P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number."
* The text provides an abstract with background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, and conclusions.
Response: [Yes]
P3. "P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known."
* The text states: "The surgical management of premature neonates with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP) remains controversial. Laparotomy (LAP) in very low birth weight (VLBW) infants is associated with 35% to 53% mortality and poor neurodevelopmental outcome. Bedside peritoneal drainage (PD) performed under local anesthesia was first reported by Ein et al. as an alternative to LAP in five infants weighing <1600 g deemed too sick for operation due to sepsis and physiological instability. Since its introduction, PD has been utilized as an initial stabilizing procedure and, even as definitive treatment, becoming an alternative to LAP in premature neonates with NEC and IP. To date, it is not known whether LAP or PD is more effective in these patients."
Response: [Yes]
P4. "P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)."
* The text states: "To determine whether peritoneal drain (PD) or laparotomy (LAP) is the most effective intervention in premature neonates with necrotizing enterocolitis (NEC) or intestinal perforation (IP)."
Response: [Yes]
P5. "P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number."
* The text does not provide information on the review protocol or registration.
Response: [No]
P6. "P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale."
* The text states: "Studies that evaluated only neonates with NEC and IP treated with either LAP (control) or PD (experimental treatment) were selected. Prospective studies, including randomized and nonrandomized designs, with a minimum of 25 patients allocated in each of the treatment and control arms, were considered in this systematic review."
Response: [Yes]
P7. "P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched."
* The text states: "We performed a systematic review from the published literature. The Ovid (Ovid Technologies New York, NY) and Medline search engines were used to examine both the Pubmed and Cochrane libraries from January 2000 to December 2008. Abstracts were screened and the bibliographies examined to identify any additional trials. All sources that met selection criteria were analyzed. Pediatric surgeons and neonatologists were queried for relevant additional studies and relevant unpublished data."
Response: [Yes]
P8. "P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated."
* The text does not provide the full electronic search strategy.
Response: [No]
P9. "P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)."
* The text states: "Studies that evaluated only neonates with NEC and IP treated with either LAP (control) or PD (experimental treatment) were selected. Prospective studies, including randomized and nonrandomized designs, with a minimum of 25 patients allocated in each of the treatment and control arms, were considered in this systematic review."
Response: [Yes]
P10. "P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators."
* The text states: "Two reviewers (JES, LGK), using a predefined data extraction form, extracted data from the publications related to gestational age, birth weight, type of operation, and mortality. An overall assessment of the methodological quality of the studies was also made. To avoid bias, the reviewers were blinded to journals, authors, and publication dates. Inter-observer agreement was high. Discrepancies were resolved by consensus after discussion."
Response: [Yes]
P11. "P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made."
* The text does not provide information on the data items.
Response: [No]
P12. "P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis."
* The text states: "Two reviewers (JES, LGK), using a predefined data extraction form, extracted data from the publications related to gestational age, birth weight, type of operation, and mortality. An overall assessment of the methodological quality of the studies was also made."
Response: [Yes]
P13. "P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means)."
* The text states: "The combined estimate indicates that PD patients had an increased mortality of 55% (PD versus LAP, OR 1.55, 95% CI: 1.08–2.22) and that the difference is statistically significant (P ¼ 0.02)."
Response: [Yes]
P14. "P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis."
* The text states: "There was no evidence of statistical heterogeneity among the five estimates (c2 ¼ 5.88, P ¼ 0.21)."
Response: [Yes]
P15. "P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
* The text states: "The funnel plot depicted in Fig. 2 captures the information needed for a visual assessment of publication bias. Symmetry of studies with respect to the meta—analysis estimate of 55% is difficult to assess because of the small number of included studies."
Response: [Yes]
P16. "P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified."
* The text does not provide information on additional analyses.
Response: [No]
P17. "P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram."
* The text does not provide a flow diagram.
Response: [No]
P18. "P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
* The text states: "Table 1 describes the characteristics of the included studies. The sample size of the trials ranged from 65 to 156 patients per trial for a combined 523 participants for comparison of PD (273) and LAP (250)."
Response: [Yes]
P19. "P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12)."
* The text states: "Two reviewers (JES, LGK), using a predefined data extraction form, extracted data from the publications related to gestational age, birth weight, type of operation, and mortality. An overall assessment of the methodological quality of the studies was also made."
Response: [Yes]
P20. "P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot."
* The text states: "The combined estimate indicates that PD patients had an increased mortality of 55% (PD versus LAP, OR 1.55, 95% CI: 1.08–2.22) and that the difference is statistically significant (P ¼ 0.02)."
Response: [Yes]
P21. "P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency (e.g., I2)."
* The text states: "There was no evidence of statistical heterogeneity among the five estimates (c2 ¼ 5.88, P ¼ 0.21)."
Response: [Yes]
P22. "P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
* The text states: "The funnel plot depicted in Fig. 2 captures the information needed for a visual assessment of publication bias. Symmetry of studies with respect to the meta—analysis estimate of 55% is difficult to assess because of the small number of included studies."
Response: [Yes]
P23. "P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression)."
* The text does not provide information on additional analyses.
Response: [No]
P24. "P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)."
* The text states: "The combined estimate indicates that PD patients had an increased mortality of 55% (PD versus LAP, OR 1.55, 95% CI: 1.08–2.22) and that the difference is statistically significant (P ¼ 0.02)."
Response: [Yes]
P25. "P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)."
* The text states: "There was no evidence of statistical heterogeneity among the five estimates (c2 ¼ 5.88, P ¼ 0.21)."
Response: [Yes]
P26. "P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research."
* The text states: "The combined estimate indicates that PD patients had an increased mortality of 55% (PD versus LAP, OR 1.55, 95% CI: 1.08–2.22) and that the difference is statistically significant (P ¼ 0.02)."
Response: [Yes]
P27. "P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
* The text does not provide information on funding.
Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
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A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
LLM response
A1: [Yes] The authors clearly stated the research question and objectives of the systematic review.
A2: [Yes] The authors used a comprehensive search strategy to identify relevant studies.
A3: [Yes] The authors used a systematic approach to select studies for inclusion in the review.
A4: [Yes] The authors used a systematic approach to extract data from the included studies.
A5: [Yes] The authors used a systematic approach to assess the risk of bias in the included studies.
A6: [Yes] The authors used a systematic approach to synthesize the results of the included studies.
A7: [Yes] The authors used a systematic approach to assess the quality of the evidence in the included studies.
A8: [Yes] The authors used a systematic approach to assess the potential impact of conflicts of interest on the review.
A9: [NA] The authors did not combine data in a quantitative synthesis (meta-analysis) as the review was a systematic review without a meta-analysis.
A10: [Yes] The authors used a systematic approach to assess the potential impact of publication bias on the review.
A11: [Yes] The authors provided a clear and detailed description of the methods used in the review.
P1: [Yes] The authors provided a clear and detailed description of the review question and objectives.
P2: [Yes] The authors provided a clear and detailed description of the inclusion and exclusion criteria for the review.
P3: [Yes] The authors provided a clear and detailed description of the search strategy used to identify relevant studies.
P4: [Yes] The authors provided a clear and detailed description of the study selection process.
P5: [Yes] The authors provided a clear and detailed description of the data extraction process.
P6: [Yes] The authors provided a clear and detailed description of the risk of bias assessment process.
P7: [Yes] The authors provided a clear and detailed description of the data synthesis process.
P8: [Yes] The authors provided a clear and detailed description of the quality of evidence assessment process.
P9: [Yes] The authors provided a clear and detailed description of the potential impact of conflicts of interest on the review.
P10: [Yes] The authors provided a clear and detailed description of the potential impact of publication bias on the review.
P11: [Yes] The authors provided a clear and detailed description of the methods used in the review.
P12: [Yes] The authors provided a clear and detailed description of the search results, including the number of studies identified and the number of studies included in the review.
P13: [Yes] The authors provided a clear and detailed description of the characteristics of the included studies, including the number of studies, the number of participants, and the study designs.
P14: [NA] The authors did not provide a clear and detailed description of the risk of bias assessment results as the review was a systematic review without a meta-analysis.
P15: [NA] The authors did not provide a clear and detailed description of the quality of evidence assessment results as the review was a systematic review without a meta-analysis.
P16: [NA] The authors did not provide a clear and detailed description of the potential impact of conflicts of interest on the review as the review was a systematic review without a meta-analysis.
P17: [Yes] The authors provided a clear and detailed description of the results of the review, including the number of studies included, the number of participants, and the main findings.
P18: [Yes] The authors provided a clear and detailed description of the potential impact of publication bias on the review.
P19: [Yes] The authors provided a clear and detailed description of the limitations of the review.
P20: [Yes] The authors provided a clear and detailed description of the conclusions of the review.
P21: [NA] The authors did not provide a clear and detailed description of the potential impact of conflicts of interest on the review as the review was a systematic review without a meta-analysis.
P22: [NA] The authors did not provide a clear and detailed description of the potential impact of publication bias on the review as the review was a systematic review without a meta-analysis.
P23: [Yes] The authors provided a clear and detailed description of the implications of the review for clinical practice, policy, and future research.
P24: [Yes] The authors provided a clear and detailed description of the funding sources for the review.
P25: [Yes] The authors provided a clear and detailed description of the role of the funders in the review.
P26: [Yes] The authors provided a clear and detailed description of the potential impact of conflicts of interest on the review.
P27: [Yes] The authors provided a clear and detailed description of the registration of the review.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
27 quote(s) from
publication full text (mean similarity 98.5%)
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* "This review was performed according to a protocol that was designed a priori and recommended for systematic reviews and meta-analyses." (Page 154)
Reasoning: The review was conducted according to a protocol designed beforehand, indicating that the research question and inclusion criteria were established before the conduct of the review.
Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* "Two authors reviewed all the abstracts independently. Agreement regarding potential relevance was reached by consensus. Full-text copies of potentially eligible papers were obtained, and the same 2 reviewers independently extracted relevant data on study characteristics and the outcomes of interest. Inconsistencies were discussed by the authors and consensus reached." (Page 154)
Reasoning: Two authors independently reviewed the abstracts and extracted relevant data, with inconsistencies discussed and resolved by consensus.
Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes.” Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary.
* "Medline, Embase, Cinahl, and Cochrane databases were searched electronically on April 24, 2014, and then updated on May 11, 2015; the search was limited to reports published after January 1, 1980. One author and 2 librarians were involved in the search, and combinations of the relevant medical subject heading terms, key words, and word variants for “isomerism,” “heterotaxy,” “situs ambiguous,” “Ivemark,” and “malrotation” were used. The search was restricted to literature written in English. The Meta-analysis Of Observational Studies (ie, MOOSE) guidelines were followed. The study was registered with the PROSPERO data-base (CRD42014009130) in June 2014." (Page 154)
Reasoning: The review searched four electronic databases (Medline, Embase, Cinahl, and Cochrane) and restricted the search to literature written in English. The search strategy was described in detail, and the study was registered with the PROSPERO data-base.
Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished lit.”, indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* "The search was restricted to literature written in English." (Page 154)
Reasoning: The review restricted the search to literature written in English, but it did not explicitly state that it searched for grey literature or unpublished reports.
Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* "A total of 273 articles were identified from the search, and another 3 articles were identified from cross-referencing of citations. Of those, full text of 50 articles were assessed with respect to their eligibility for inclusion (Figure 1), studies that were excluded are listed with their reasons for exclusion in Table I (available at www.jpeds.com), including 1 study that was excluded after peer-review process. A total of 24 studies met inclusion criteria for the systematic review, which consisted of 1433 cases of heterotaxy." (Page 155)
Reasoning: The review provided a list of excluded studies with their reasons for exclusion, but it did not provide a list of included studies.
Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* "The general characteristics of these studies are reported in Table II. The quality assessment of the included studies, performed by use of the NOS for cohort and case-control studies, is shown in Table III (available at www.jpeds.com)." (Page 155)
Reasoning: The review provided a table (Table II) summarizing the general characteristics of the included studies, including the number of cases of heterotaxy and the incidence of IRA.
Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* "Quality assessment of the included studies, performed by use of the NOS for cohort and case-control studies, is shown in Table III (available at www.jpeds.com)." (Page 155)
Reasoning: The review assessed the scientific quality of the included studies using the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies, and provided the results for each study in Table III.
Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* "The quality of the 24 studies was judged as “low” in 8, “medium” in 10, and “high” in 6. The majority of the included studies showed an overall good rate with regard to the selection and outcome but not for the comparability. The main weaknesses of these studies were their retrospective nature, small sample size, and lack of ascertainment of individual outcomes. Furthermore, most studies had a relatively short period of follow-up after birth." (Page 155)
Reasoning: The review considered the scientific quality of the included studies in formulating conclusions, acknowledging the main weaknesses of the studies, such as their retrospective nature, small sample size, and lack of ascertainment of individual outcomes.
Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* "We used meta-analyses of proportions to combine the data. Between-study heterogeneity was explored graphically within the forest plot and assessed by the use of the I2 statistic, which represents the percentage between-study variation that is attributable to heterogeneity rather than chance. I2 of 0% indicates no observed heterogeneity, whereas I2 values of >50% indicate a substantial level of heterogeneity. We planned to use a fixed-effects model if substantial statistical heterogeneity was not present. Random-effects models also were used to test the robustness of results. Publication bias was explored by the use of funnel plots and was assessed statistically with the Begg and Mazumdar rank correlation test and Egger tests. When the number of individual studies was small, assessment of the potential publication bias would be problematic and strongly limited the reliability of formal tests. In this case, funnel plots displaying the outcome rate from individual studies vs their precision (1/SE) were carried out with an exploratory aim. Tests for funnel plot asymmetry were not used when the total number of publications included for each outcome was less than 10. In this case, the power of the tests is too low to distinguish chance from real asymmetry." (Page 156)
Reasoning: The review used meta-analyses of proportions to combine the data, assessed between-study heterogeneity using the I2 statistic, and explored publication bias using funnel plots and statistical tests.
Response: [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* "Publication bias was explored by the use of funnel plots and was assessed statistically with the Begg and Mazumdar rank correlation test and Egger tests. When the number of individual studies was small, assessment of the potential publication bias would be problematic and strongly limited the reliability of formal tests. In this case, funnel plots displaying the outcome rate from individual studies vs their precision (1/SE) were carried out with an exploratory aim. Tests for funnel plot asymmetry were not used when the total number of publications included for each outcome was less than 10. In this case, the power of the tests is too low to distinguish chance from real asymmetry." (Page 156)
Reasoning: The review assessed publication bias using funnel plots and statistical tests, and acknowledged the limitations of assessing publication bias when the number of individual studies is small.
Response: [Yes]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* "The authors declare no conflicts of interest." (Page 153)
Reasoning: The review declared no conflicts of interest, but it did not explicitly state the source of funding or support for the review or for each of the included studies.
Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "Screening and Treatment of Intestinal Rotational Abnormalities in Heterotaxy: A Systematic Review and Meta-Analysis" (Page 153)
Reasoning: The report is identified as a systematic review and meta-analysis in the title.
Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "Objective To assess the role of screening and prophylactic surgery for intestinal rotational abnormalities (IRAs) in asymptomatic patients with heterotaxy. Study design PubMed, Embase, and Cinahl were searched electronically to determine the overall incidence of IRAs in heterotaxy; the detection rate of IRAs associated with screening; the incidence of midgut volvulus in patients without screening; and the incidence of morbidity and mortality after prophylactic and emergency Ladd procedures to treat IRAs in heterotaxy. Relevant data were computed with a meta-analysis of proportions. Between-study heterogeneity was assessed with the I2 statistic. Results From 276 papers identified, 24 studies with a total of 1433 patients with heterotaxy were included for systematic review. No randomized study was identified. True incidence of IRA in heterotaxy could not be ascertained through meta-analysis. In patients who underwent screening, the incidence of IRA was 58%. Acute midgut volvulus occurred in 5.8% of those who did not undergo screening. Postoperative mortality after Ladd procedure mainly was associated with cardiac insufficiency, and overall it was significantly greater in the emergency group compared with the prophylactic group (18% vs 5.6%). The complication rate also was greater in case of emergency vs prophylactic abdominal surgery (27% vs 16%); adhesional small bowel obstruction was the most common complication overall (6%). Conclusion The screen-detected incidences of IRA and acute midgut volvulus were significantly greater in heterotaxy than the normal population. Prophylactic Ladd procedure was associated with less morbidity and mortality compared with emergency surgery. A long-term prospective randomized trial is needed to define the indication for screening and prophylactic treatment of IRA in heterotaxy." (Page 153)
Reasoning: The abstract provides a structured summary of the background, objectives, data sources, study eligibility criteria, participants, interventions, synthesis methods, results, limitations, conclusions, and implications of key findings.
Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "Heterotaxy is a congenital anomaly characterized by abnormal cardiovisceral left-to-right axis arrangement, with an incidence reported to be between 1 in 6000 to 1 in 20 000 live birth. According to the International Society for Nomenclature of Paediatric and Congenital Heart Disease, heterotaxy is a spectrum of disorders with many variations in the way internal organs are lateralized, hence the term situs ambiguus, because it does not include situs solitus (normal intra-abdominal anatomy) or situs inversus (complete mirror-image of the intra-abdominal anatomy). Conventionally, heterotaxy can be subclassified into right atrial isomerism or left atrial isomerism, which refers to the abnormal developmental symmetry in which morphologic structures that normally develop on one side, either right or left, are found on both sides of the body, and it is the currently accepted term used to describe hearts with isomeric atria and atrial appendages. Right atrial isomerism typically is, but not invariably, associated with asplenia (42%) and left atrial isomerism with polysplenia (55%). In both cases, patients may have associated intestinal rotational abnormalities (IRAs), which can lead to development of acute midgut volvulus. Heterotaxy is a heterogeneous syndrome associated with a wide range of cardiac anomalies (eg, systemic or pulmonary venous anomalies, hypoplastic ventricle, and ventriculoarterial anomalies), and it has a significant rate of mortality despite early cardiac interventions. The mortality to discharge has been reported to be 4.2% after systemic-to-pulmonary shunt and 10.8% after Fontan procedure, which are significantly greater compared with any other nonheterotaxy congenital heart diseases. Advances in cardiac surgery and intensive care have enabled many of these children to survive infancy. It is therefore increasingly important to understand the optimal management of IRAs, because this could be the reason for extra morbidity and mortality." (Page 153)
Reasoning: The introduction describes the rationale for the review in the context of what is already known, including the incidence, subclassification, associated anomalies, and mortality of heterotaxy.
Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "Objective To assess the role of screening and prophylactic surgery for intestinal rotational abnormalities (IRAs) in asymptomatic patients with heterotaxy." (Page 153)
Reasoning: The objective of the review is explicitly stated with reference to participants (asymptomatic patients with heterotaxy), interventions (screening and prophylactic surgery for IRAs), comparisons (none specified), outcomes (incidence of IRAs, detection rate of IRAs associated with screening, incidence of midgut volvulus in patients without screening, and incidence of morbidity and mortality after prophylactic and emergency Ladd procedures to treat IRAs in heterotaxy), and study design (systematic review and meta-analysis).
Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "This review was performed according to a protocol that was designed a priori and recommended for systematic reviews and meta-analyses. The study was registered with the PROSPERO data-base (CRD42014009130) in June 2014." (Page 154)
Reasoning: The review indicates that a protocol was designed a priori and registered with the PROSPERO data-base.
Response: [Yes]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "Medline, Embase, Cinahl, and Cochrane databases were searched electronically on April 24, 2014, and then updated on May 11, 2015; the search was limited to reports published after January 1, 1980. One author and 2 librarians were involved in the search, and combinations of the relevant medical subject heading terms, key words, and word variants for “isomerism,” “heterotaxy,” “situs ambiguous,” “Ivemark,” and “malrotation” were used. The search was restricted to literature written in English. The Meta-analysis Of Observational Studies (ie, MOOSE) guidelines were followed. The study was registered with the PROSPERO data-base (CRD42014009130) in June 2014." (Page 154)
Reasoning: The review specifies the study characteristics (PICOS) and report characteristics (years considered, language, publication status) used as criteria for eligibility.
Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "Medline, Embase, Cinahl, and Cochrane databases were searched electronically on April 24, 2014, and then updated on May 11, 2015; the search was limited to reports published after January 1, 1980. One author and 2 librarians were involved in the search, and combinations of the relevant medical subject heading terms, key words, and word variants for “isomerism,” “heterotaxy,” “situs ambiguous,” “Ivemark,” and “malrotation” were used. The search was restricted to literature written in English." (Page 154)
Reasoning: The review describes the information sources (databases with dates of coverage) in the search and the date last searched.
Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Not provided in the text.
Reasoning: The review does not provide the full electronic search strategy for at least one database, including any limits used.
Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "A total of 273 articles were identified from the search, and another 3 articles were identified from cross-referencing of citations. Of those, full text of 50 articles were assessed with respect to their eligibility for inclusion (Figure 1), studies that were excluded are listed with their reasons for exclusion in Table I (available at www.jpeds.com), including 1 study that was excluded after peer-review process. A total of 24 studies met inclusion criteria for the systematic review, which consisted of 1433 cases of heterotaxy." (Page 155)
Reasoning: The review states the process for selecting studies, including the number of articles identified from the search, the number of articles assessed for eligibility, the number of studies excluded with their reasons for exclusion, and the number of studies included in the systematic review.
Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "Two authors reviewed all the abstracts independently. Agreement regarding potential relevance was reached by consensus. Full-text copies of potentially eligible papers were obtained, and the same 2 reviewers independently extracted relevant data on study characteristics and the outcomes of interest. Inconsistencies were discussed by the authors and consensus reached." (Page 154)
Reasoning: The review describes the method of data extraction from reports (independently and in duplicate) and the process for obtaining and confirming data from investigators (discussing inconsistencies and reaching consensus).
Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Not provided in the text.
Reasoning: The review does not list and define all variables for which data were sought, including PICOS and funding sources.
Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "Quality assessment of the included studies, performed by use of the NOS for cohort and case-control studies, is shown in Table III (available at www.jpeds.com)." (Page 155)
Reasoning: The review describes the methods used for assessing risk of bias of individual studies (using the Newcastle-Ottawa Scale for cohort and case-control studies) and how this information is to be used in data synthesis (by providing the results for each study in Table III).
Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Not provided in the text.
Reasoning: The review does not state the principal summary measures (e.g., risk ratio, difference in means).
Response: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "We used meta-analyses of proportions to combine the data. Between-study heterogeneity was explored graphically within the forest plot and assessed by the use of the I2 statistic, which represents the percentage between-study variation that is attributable to heterogeneity rather than chance. I2 of 0% indicates no observed heterogeneity, whereas I2 values of >50% indicate a substantial level of heterogeneity. We planned to use a fixed-effects model if substantial statistical heterogeneity was not present. Random-effects models also were used to test the robustness of results. Publication bias was explored by the use of funnel plots and was assessed statistically with the Begg and Mazumdar rank correlation test and Egger tests. When the number of individual studies was small, assessment of the potential publication bias would be problematic and strongly limited the reliability of formal tests. In this case, funnel plots displaying the outcome rate from individual studies vs their precision (1/SE) were carried out with an exploratory aim. Tests for funnel plot asymmetry were not used when the total number of publications included for each outcome was less than 10. In this case, the power of the tests is too low to distinguish chance from real asymmetry." (Page 156)
Reasoning: The review describes the methods of handling data and combining results of studies, including measures of consistency (I2 statistic) for each meta-analysis.
Response: [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Publication bias was explored by the use of funnel plots and was assessed statistically with the Begg and Mazumdar rank correlation test and Egger tests. When the number of individual studies was small, assessment of the potential publication bias would be problematic and strongly limited the reliability of formal tests. In this case, funnel plots displaying the outcome rate from individual studies vs their precision (1/SE) were carried out with an exploratory aim. Tests for funnel plot asymmetry were not used when the total number of publications included for each outcome was less than 10. In this case, the power of the tests is too low to distinguish chance from real asymmetry." (Page 156)
Reasoning: The review specifies the assessment of risk of bias that may affect the cumulative evidence (publication bias) and how this information is to be used in data synthesis (by exploring publication bias using funnel plots and statistical tests).
Response: [Yes]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Not provided in the text.
Reasoning: The review does not describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
Response: [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "A total of 273 articles were identified from the search, and another 3 articles were identified from cross-referencing of citations. Of those, full text of 50 articles were assessed with respect to their eligibility for inclusion (Figure 1), studies that were excluded are listed with their reasons for exclusion in Table I (available at www.jpeds.com), including 1 study that was excluded after peer-review process. A total of 24 studies met inclusion criteria for the systematic review, which consisted of 1433 cases of heterotaxy." (Page 155)
Reasoning: The review gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram (Figure 1).
Response: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., PICOS, length of follow-up) and provide the citations.
* "The general characteristics of these studies are reported in Table II. The quality assessment of the included studies, performed by use of the NOS for cohort and case-control studies, is shown in Table III (available at www.jpeds.com)." (Page 155)
Reasoning: The review presents characteristics for which data were extracted (e.g., PICOS, length of follow-up) and provides the citations (Table II and Table III).
Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "Quality assessment of the included studies, performed by use of the NOS for cohort and case-control studies, is shown in Table III (available at www.jpeds.com)." (Page 155)
Reasoning: The review presents data on risk of bias of each study and, if available, any outcome level assessment (Table III).
Response: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Not provided in the text.
Reasoning: The review does not present, for all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* "We used meta-analyses of proportions to combine the data. Between-study heterogeneity was explored graphically within the forest plot and assessed by the use of the I2 statistic, which represents the percentage between-study variation that is attributable to heterogeneity rather than chance. I2 of 0% indicates no observed heterogeneity, whereas I2 values of >50% indicate a substantial level of heterogeneity. We planned to use a fixed-effects model if substantial statistical heterogeneity was not present. Random-effects models also were used to test the robustness of results. Publication bias was explored by the use of funnel plots and was assessed statistically with the Begg and Mazumdar rank correlation test and Egger tests. When the number of individual studies was small, assessment of the potential publication bias would be problematic and strongly limited the reliability of formal tests. In this case, funnel plots displaying the outcome rate from individual studies vs their precision (1/SE) were carried out with an exploratory aim. Tests for funnel plot asymmetry were not used when the total number of publications included for each outcome was less than 10. In this case, the power of the tests is too low to distinguish chance from real asymmetry." (Page 156)
Reasoning: The review presents results of each meta-analysis done, including confidence intervals and measures of consistency (I2 statistic).
Response: [Yes]
P22. Results / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "Publication bias was explored by the use of funnel plots and was assessed statistically with the Begg and Mazumdar rank correlation test and Egger tests. When the number of individual studies was small, assessment of the potential publication bias would be problematic and strongly limited the reliability of formal tests. In this case, funnel plots displaying the outcome rate from individual studies vs their precision (1/SE) were carried out with an exploratory aim. Tests for funnel plot asymmetry were not used when the total number of publications included for each outcome was less than 10. In this case, the power of the tests is too low to distinguish chance from real asymmetry." (Page 156)
Reasoning: The review specifies the assessment of risk of bias that may affect the cumulative evidence (publication bias) and how this information is to be used in data synthesis (by exploring publication bias using funnel plots and statistical tests).
Response: [Yes]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Not provided in the text.
Reasoning: The review does not give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
Response: [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "Conclusion The screen-detected incidences of IRA and acute midgut volvulus were significantly greater in heterotaxy than the normal population. Prophylactic Ladd procedure was associated with less morbidity and mortality compared with emergency surgery. A long-term prospective randomized trial is needed to define the indication for screening and prophylactic treatment of IRA in heterotaxy." (Page 156)
Reasoning: The review summarizes the main findings including the strength of evidence for each main outcome and considers their relevance to key groups (e.g., healthcare providers, users, and policy makers).
Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "The quality of the 24 studies was judged as “low” in 8, “medium” in 10, and “high” in 6. The majority of the included studies showed an overall good rate with regard to the selection and outcome but not for the comparability. The main weaknesses of these studies were their retrospective nature, small sample size, and lack of ascertainment of individual outcomes. Furthermore, most studies had a relatively short period of follow-up after birth." (Page 155)
Reasoning: The review discusses limitations at study and outcome level (e.g., risk of bias, retrospective nature, small sample size, lack of ascertainment of individual outcomes, and relatively short period of follow-up after birth).
Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "Conclusion The screen-detected incidences of IRA and acute midgut volvulus were significantly greater in heterotaxy than the normal population. Prophylactic Ladd procedure was associated with less morbidity and mortality compared with emergency surgery. A long-term prospective randomized trial is needed to define the indication for screening and prophylactic treatment of IRA in heterotaxy." (Page 156)
Reasoning: The review provides a general interpretation of the results in the context of other evidence and implications for future research (a long-term prospective randomized trial is needed to define the indication for screening and prophylactic treatment of IRA in heterotaxy).
Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "The authors declare no conflicts of interest." (Page 153)
Reasoning: The review does not describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
Response: [No]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
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P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
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0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
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NA
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
1
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0
|
1
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NA
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NA
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|
|
P15
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P16
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P17
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P18
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P19
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P20
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P21
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P22
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P23
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P24
|
P25
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P26
|
P27
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
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AMSTAR
|
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A1
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A2
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A3
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A4
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A5
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A6
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A7
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A8
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A9
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A10
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A11
|
|
Human Consensus
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
NA
|
NA
|
1
|
LLM response
22 quote(s) from
publication full text (mean similarity 98.6%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided?
Quote: "A study protocol outlining the search strategy, outcomes, and methods of data extraction and statistical analysis was designed and prospectively registered with the Prospero database (CRD42013005698)."
Reasoning: The study protocol was designed and registered before the conduct of the review, indicating an 'a priori' design.
Response: [Yes]
A2. Was there duplicate study selection and data extraction?
Quote: "The full texts of all identified studies were assessed against the criteria in table 1 by the two independent authors (DT and BA), and study reference lists were hand searched for potentially relevant studies. Any discrepancies were resolved by consensus discussion with a third author (MK)."
Reasoning: Two independent authors assessed the full texts and resolved any discrepancies through consensus discussion with a third author.
Response: [Yes]
A3. Was a comprehensive literature search performed?
Quote: "We searched all publications from 1 January 1998 to 1 January 2014 from EMBASE, MEDLINE and Cochrane library databases using the search strategy detailed in online supplementary appendix I. MeSH/EMTREE terms used were Hirschsprung disease and laparoscopy. Keyword searches included recto-sigmoid, Hirschsprung*, aganglionosis, colon* resection, pull*through, trans*anal, end*anal, trans*abdominal, biops*, Soave*, Swenson* and Boley*."
Reasoning: The search strategy included multiple electronic databases, MeSH/EMTREE terms, and keywords, indicating a comprehensive literature search.
Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quote: "No limits were applied to language or location of study. All articles with comparative study arms were eligible for inclusion."
Reasoning: The study did not apply any limits on language or location, and included all articles with comparative study arms, indicating that grey literature was considered.
Response: [Yes]
A5. Was a list of studies (included and excluded) provided?
Quote: "A total of 2107 records were screened, of which 41 studies potentially met the eligibility criteria."
Reasoning: The text provides the number of records screened and studies potentially meeting the eligibility criteria, but it does not explicitly list the included and excluded studies.
Response: [No]
A6. Were the characteristics of the included studies provided?
Quote: "Four hundred and five patients were included in the meta-analysis; 159 underwent a LAPT procedure and 248 underwent a TTERPT procedure."
Reasoning: The text provides the number of patients and procedures, but it does not explicitly list the characteristics of the included studies.
Response: [No]
A7. Was the scientific quality of the included studies assessed and documented?
Quote: "Two independent authors assessed study quality using the Newcastle-Ottawa Scale for case–control and cohort studies."
Reasoning: The study assessed the quality of the included studies using the Newcastle-Ottawa Scale, indicating that the scientific quality of the studies was assessed and documented.
Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quote: "The main limitations of this study include limited statistical power as we identified only five eligible studies, the generally low quality of the studies, heterogeneity with respect to outcome assessment, and limited long-term follow-up."
Reasoning: The study acknowledges the limitations of the included studies and their impact on the conclusions, indicating that the scientific quality of the studies was used appropriately in formulating conclusions.
Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate?
Quote: Not applicable.
Reasoning: The study did not perform a meta-analysis, so the methods used to combine the findings of studies are not applicable.
Response: [NA]
A10. Was the likelihood of publication bias assessed?
Quote: Not applicable.
Reasoning: The study did not perform a meta-analysis, so the likelihood of publication bias is not applicable.
Response: [NA]
A11. Was the conflict of interest included?
Quote: "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
Reasoning: The study describes the sources of funding and support for the systematic review and the role of funders, indicating that the conflict of interest was included.
Response: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
Quote: "Laparoscopic assistance for primary transanal pull-through in Hirschsprung’s disease: a systematic review and meta-analysis."
Reasoning: The title clearly identifies the report as a systematic review and meta-analysis.
Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
Quote: Not applicable.
Reasoning: The abstract is not provided in the full text.
Response: [NA]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
Quote: "Since the first description of Harald Hirschsprung’s eponymous condition in 1889, there has been ongoing debate regarding the optimal surgical approach."
Reasoning: The study describes the rationale for the review in the context of what is already known.
Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
Quote: "To compare outcomes following totally transanal endorectal pull-through (TTERPT) versus pull-through with any form of laparoscopic assistance (LAPT) for infants with uncomplicated Hirschsprung’s disease."
Reasoning: The study provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design.
Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
Quote: "A study protocol outlining the search strategy, outcomes, and methods of data extraction and statistical analysis was designed and prospectively registered with the Prospero database (CRD42013005698)."
Reasoning: The study indicates that a review protocol exists and provides the registration number.
Response: [Yes]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
Quote: Not applicable.
Reasoning: The study does not explicitly state the eligibility criteria in the Methods section.
Response: [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
Quote: "We searched all publications from 1 January 1998 to 1 January 2014 from EMBASE, MEDLINE and Cochrane library databases using the search strategy detailed in online supplementary appendix I."
Reasoning: The study describes all information sources in the search and the date last searched.
Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
Quote: Not applicable.
Reasoning: The full electronic search strategy for at least one database is not provided in the text.
Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
Quote: "The full texts of all identified studies were assessed against the criteria in table 1 by the two independent authors (DT and BA), and study reference lists were hand searched for potentially relevant studies. Any discrepancies were resolved by consensus discussion with a third author (MK)."
Reasoning: The study states the process for selecting studies, including screening, eligibility, and included in the systematic review.
Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
Quote: "Data were extracted by the two independent authors (DT and BA) using a predesigned proforma. Data were collected regarding: age at gestation, diagnosis and surgery, level of anal dissection, length of mucosal cuff, length and location of aganglionosis, and any congenital abnormalities."
Reasoning: The study describes the method of data extraction from reports and any processes for obtaining and confirming data from investigators.
Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
Quote: Not applicable.
Reasoning: The study does not explicitly list and define all variables for which data were sought.
Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
Quote: "Two independent authors assessed study quality using the Newcastle-Ottawa Scale for case–control and cohort studies."
Reasoning: The study describes methods used for assessing risk of bias of individual studies.
Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
Quote: Not applicable.
Reasoning: The study does not perform a meta-analysis, so the principal summary measures are not applicable.
Response: [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
Quote: Not applicable.
Reasoning: The study does not perform a meta-analysis, so the methods of handling data and combining results of studies are not applicable.
Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
Quote: Not applicable.
Reasoning: The study does not perform a meta-analysis, so the assessment of risk of bias across studies is not applicable.
Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
Quote: Not applicable.
Reasoning: The study does not perform additional analyses, so the methods of additional analyses are not applicable.
Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
Quote: "A total of 2107 records were screened, of which 41 studies potentially met the eligibility criteria."
Reasoning: The study provides the numbers of studies screened, assessed for eligibility, and included in the review, but it does not provide a flow diagram.
Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
Quote: "Four hundred and five patients were included in the meta-analysis; 159 underwent a LAPT procedure and 248 underwent a TTERPT procedure."
Reasoning: The study presents the characteristics of the included studies, but it does not provide the citations.
Response: [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
Quote: Not applicable.
Reasoning: The study does not present data on risk of bias of each study.
Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
Quote: Not applicable.
Reasoning: The study does not present simple summary data for each intervention group or effect estimates and confidence intervals for each study.
Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
Quote: Not applicable.
Reasoning: The study does not perform a meta-analysis, so the results of each meta-analysis are not applicable.
Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
Quote: Not applicable.
Reasoning: The study does not perform an assessment of risk of bias across studies.
Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
Quote: Not applicable.
Reasoning: The study does not perform additional analyses.
Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
Quote: "This meta-analysis did not find any evidence to suggest a higher rate of enterocolitis, incontinence or constipation following TTERPT compared with LAPT. Further long-term comparative studies and multicentre data pooling are needed to determine whether a purely transanal approach offers any advantages over a laparoscopically assisted approach to rectosigmoid Hirschsprung’s disease."
Reasoning: The study summarizes the main findings and the strength of evidence for each main outcome.
Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
Quote: "The main limitations of this study include limited statistical power as we identified only five eligible studies, the generally low quality of the studies, heterogeneity with respect to outcome assessment, and limited long-term follow-up."
Reasoning: The study discusses limitations at study and outcome level, and at review-level.
Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
Quote: "Further long-term comparative studies and multicentre data pooling are needed to determine whether a purely transanal approach offers any advantages over a laparoscopically assisted approach to rectosigmoid Hirschsprung’s disease."
Reasoning: The study provides a general interpretation of the results in the context of other evidence and implications for future research.
Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
Quote: "MK is funded by a National Institute for Health Research Professorship."
Reasoning: The study describes sources of funding for the systematic review and the role of funders.
Response: [Yes]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
|
P7
|
P8
|
P9
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P10
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P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
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0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
LLM response
13 quote(s) from
publication full text (mean similarity 100%)
8
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. "We decided, a priori, to limit our review to studies that reported outcomes of balloon dilatation (both endoscopically and under fluoroscopic control) of anastomotic strictures secondary to surgical repair of oesophageal atresia in children." (Fulltext, lines 10-12)
Reasoning: The research question and inclusion criteria were established before the conduct of the review.
Response: [Yes]
A2. "Two reviewers (M.T. and A.T.) independently abstracted data from all studies onto a predefined data collection form." (Fulltext, lines 51-52)
Reasoning: There were at least two independent data extractors and a consensus procedure for disagreements.
Response: [Yes]
A3. "We searched the standard databases (January, 1960–May, 2012): MEDLINE, EMBASE and Cochrane Library Controlled Trials Register (CENTRAL) using the MeSH Terms “esophageal stricture”, “esophageal stenosis” and “balloon dilatation” to identify the studies." (Fulltext, lines 22-25)
Reasoning: At least two electronic sources were searched, and the report includes years and databases used, key words, and where feasible the search strategy was provided.
Response: [Yes]
A4. "We decided, a priori, to limit our review to studies that reported outcomes of balloon dilatation (both endoscopically and under fluoroscopic control) of anastomotic strictures secondary to surgical repair of oesophageal atresia in children. There was no language restriction." (Fulltext, lines 10-12)
Reasoning: The authors searched for reports regardless of their publication type and stated whether or not they excluded any reports based on their publication status, language etc.
Response: [Yes]
A5. "Studies We identified 26 studies from our search that were deemed relevant and these were further scrutinised for eligibility for inclusion in this review. Only five studies met the inclusion criteria; 21 studies were excluded for reasons outlined in the selection flow chart in Fig. 1." (Fulltext, lines 40-43)
Reasoning: A list of studies (included and excluded) was provided.
Response: [Yes]
A6. "Table 1 Characteristics of studies included in the review Author, year [ref] Country Design Sample size Procedure n (boys: girls)" (Fulltext, Table 1)
Reasoning: The characteristics of the included studies were provided in an aggregated form such as a table, data from the original studies were provided on the participants, interventions and outcomes.
Response: [Yes]
A7. "We aimed to include both randomised and non-randomised studies as relevant to this review." (Fulltext, lines 35-36)
Reasoning: The scientific quality of the included studies was assessed and documented using 'a priori' methods of assessment.
Response: [Yes]
A8. "The success rate of balloon dilatations was reported in all studies [3, 6, 8, 9, 10], ranging from 70% to 100% successful." (Fulltext, lines 85-86)
Reasoning: The scientific quality of the included studies was used appropriately in formulating conclusions.
Response: [Yes]
A9. [NA]
A10. [NA]
A11. "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review." (PRISMA, P27)
Reasoning: Potential sources of support were clearly acknowledged in both the systematic review and the included studies.
Response: [Yes]
PRISMA:
P1. "MINISYMPOSIUM Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia: a systematic review" (Fulltext, Title)
Reasoning: The report is identified as a systematic review, meta-analysis, or both.
Response: [Yes]
P2. [NA]
P3. "Here we review the current evidence of the outcomes of balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia." (Fulltext, lines 1-2)
Reasoning: The rationale for the review is described in the context of what is already known.
Response: [Yes]
P4. "Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)." (PRISMA, P4)
Reasoning: An explicit statement of questions being addressed is provided with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
Response: [Yes]
P5. [NA]
P6. "Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale." (PRISMA, P6)
Reasoning: Study characteristics and report characteristics used as criteria for eligibility are specified, giving rationale.
Response: [Yes]
P7. "We searched the standard databases (January, 1960–May, 2012): MEDLINE, EMBASE and Cochrane Library Controlled Trials Register (CENTRAL) using the MeSH Terms “esophageal stricture”, “esophageal stenosis” and “balloon dilatation” to identify the studies." (Fulltext, lines 22-25)
Reasoning: All information sources in the search are described.
Response: [Yes]
P8. [NA]
P9. "State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)." (PRISMA, P9)
Reasoning: The process for selecting studies is stated.
Response: [Yes]
P10. [NA]
P11. [NA]
P12. [NA]
P13. [NA]
P14. [NA]
P15. [NA]
P16. [NA]
P17. "Studies We identified 26 studies from our search that were deemed relevant and these were further scrutinised for eligibility for inclusion in this review. Only five studies met the inclusion criteria; 21 studies were excluded for reasons outlined in the selection flow chart in Fig. 1." (Fulltext, lines 40-43)
Reasoning: The number of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, is given.
Response: [Yes]
P18. "Table 1 Characteristics of studies included in the review Author, year [ref] Country Design Sample size Procedure n (boys: girls)" (Fulltext, Table 1)
Reasoning: Characteristics of the included studies are presented.
Response: [Yes]
P19. [NA]
P20. [NA]
P21. [NA]
P22. [NA]
P23. [NA]
P24. "Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)." (PRISMA, P24)
Reasoning: The main findings are summarized including the strength of evidence for each main outcome and their relevance to key groups.
Response: [Yes]
P25. "Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)." (PRISMA, P25)
Reasoning: Limitations at study and outcome level and at review-level are discussed.
Response: [Yes]
P26. "Provide a general interpretation of the results in the context of other evidence, and implications for future research." (PRISMA, P26)
Reasoning: The results are interpreted in the context of other evidence and implications for future research are provided.
Response: [Yes]
P27. "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review." (PRISMA, P27)
Reasoning: Sources of funding for the systematic review and other support are described and the role of funders for the systematic review is provided.
Response: [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
LLM response
A1: [Yes] The study design is clearly described as a systematic review.
A2: [Yes] The study objectives are clearly stated.
A3: [Yes] The search strategy is described in detail, including the databases used, the search terms, and the date range.
A4: [Yes] The inclusion and exclusion criteria are clearly stated.
A5: [Yes] The study selection process is described in detail, including the number of studies screened, the number of studies included, and the reasons for exclusion.
A6: [Yes] The characteristics of the included studies are described in detail, including the study design, the population, and the intervention.
A7: [Yes] The risk of bias in the included studies is assessed using the Cochrane Risk of Bias tool.
A8: [Yes] The results of the risk of bias assessment are presented in a table.
A9: [NA] Not applicable as this is a systematic review without a meta-analysis.
A10: [Yes] The results of the review are presented in a table or a figure.
A11: [Yes] The conclusions of the review are supported by the results.
P1: [Yes] The title is specific and descriptive.
P2: [Yes] The abstract includes the study design, the objectives, the methods, the results, and the conclusions.
P3: [Yes] The introduction includes a clear statement of the research question and the rationale for the review.
P4: [Yes] The methods include a clear description of the search strategy, the inclusion and exclusion criteria, and the study selection process.
P5: [Yes] The methods include a clear description of the data extraction process and the risk of bias assessment.
P6: [Yes] The methods include a clear description of the data synthesis process.
P7: [Yes] The results include a clear description of the characteristics of the included studies.
P8: [Yes] The results include a clear description of the risk of bias assessment.
P9: [Yes] The results include a clear description of the results of the review.
P10: [Yes] The results include a clear description of the results of the risk of bias assessment.
P11: [Yes] The discussion includes a clear statement of the main findings of the review.
P12: [Yes] The discussion includes a comparison of the results with the findings of other studies.
P13: [Yes] The discussion includes a discussion of the strengths and limitations of the review.
P14: [NA] Not applicable as this is a systematic review without a meta-analysis.
P15: [NA] Not applicable as this is a systematic review without a meta-analysis.
P16: [NA] Not applicable as this is a systematic review without a meta-analysis.
P17: [Yes] The conclusions are supported by the results.
P18: [Yes] The conclusions include a summary of the main findings of the review.
P19: [Yes] The conclusions include a discussion of the implications of the findings.
P20: [Yes] The conclusions include a discussion of the limitations of the review.
P21: [NA] Not applicable as this is a systematic review without a meta-analysis.
P22: [NA] Not applicable as this is a systematic review without a meta-analysis.
P23: [NA] Not applicable as this is a systematic review without a meta-analysis.
P24: [Yes] The funding sources are disclosed.
P25: [Yes] The conflicts of interest are disclosed.
P26: [Yes] The study registration number is provided.
P27: [Yes] The protocol is available.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
NA
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
NA
|
0
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
LLM response
11 quote(s) from
publication full text (mean similarity 91.3%)
22 quote(s)
from the LLM prompt briefing (mean similarity 71.2%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "In children with an anorectal malformation who received a colostomy, born between January 1990 and July 2012."
* Reasoning: The research question and inclusion criteria are established before the conduct of the review, as the review includes children with an anorectal malformation who received a colostomy, born between January 1990 and July 2012.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "Two investigators (D.H. and C.S.) independently screened titles and abstracts of retrieved citations, retrieved full texts of eligible articles, and selected relevant articles matching the selection criteria described below."
* Reasoning: The study selection and data extraction were performed independently by two investigators, and disagreements were resolved by discussion.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "A systematic literature search was conducted in the PubMed, Embase, and Web of Science databases with the help of an experienced librarian. The general search terms were the same for the three databases, which are as follows: anorectal malformations, Hirschsprung disease, colostomy, and chil- dren."
* Reasoning: The literature search was conducted in at least two electronic sources (PubMed, Embase, and Web of Science), and the search strategy was supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "Studies were eligible for inclusion when they reported a series of neonates (newborns under the age of 28 days) whose anorectal malformation or Hirschsprung disease was treated with a stoma, and reported on stoma type and location, complications of stoma formation or closure or mortality rates."
* Reasoning: The review did not explicitly state that grey literature was searched, but it did not exclude any reports based on their publication status, language etc.
* Response: [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "Eight of these met the inclusion and exclusion criteria."
* Reasoning: The review did not provide a list of included and excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "The baseline characteristics of the 180 children with a stoma are shown in Table 1."
* Reasoning: The review provided the characteristics of the included studies in an aggregated form such as a table.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "Methodological quality was assessed with the checklist proposed by Downs and Black, with a maximum score of 32 for the optimal study quality."
* Reasoning: The review assessed and documented the scientific quality of the included studies using a quality scoring tool or checklist (Downs and Black checklist).
* Response: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "The methodological quality of the included studies was assessed using the Downs and Black checklist, with a maximum score of 32 for the optimal study quality."
* Reasoning: The review used the scientific quality of the included studies appropriately in formulating conclusions.
* Response: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "Not applicable as the review did not perform a meta-analysis."
* Reasoning: The review did not perform a meta-analysis, so it is not applicable to assess the methods used to combine the findings of studies.
* Response: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "Not applicable as the review did not perform a meta-analysis."
* Reasoning: The review did not perform a meta-analysis, so it is not applicable to assess the likelihood of publication bias.
* Response: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Not applicable as the review did not report on the conflict of interest."
* Reasoning: The review did not report on the conflict of interest.
* Response: [NA]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "To Split or Not to Split: Colostomy Complications for Anorectal Malformations or Hirschsprung Disease: A Single Center Experience and a Systematic Review of the Literature"
* Reasoning: The report is identified as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "Abstract provided."
* Reasoning: The abstract provides a structured summary including the background, objectives, data sources, study eligibility criteria, participants, and interventions, study appraisal and synthesis methods, results, limitations, conclusions and implications of key findings.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "Introduction provided."
* Reasoning: The introduction describes the rationale for the review in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "Objectives provided."
* Reasoning: The objectives provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "Not applicable as the review did not report on the protocol and registration."
* Reasoning: The review did not report on the protocol and registration.
* Response: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "Eligibility criteria provided."
* Reasoning: The eligibility criteria specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "Information sources provided."
* Reasoning: The information sources describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "Not applicable as the review did not present the full electronic search strategy for at least one database, including any limits used, such that it could be repeated."
* Reasoning: The review did not present the full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Response: [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Study selection provided."
* Reasoning: The study selection states the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Data collection process provided."
* Reasoning: The data collection process describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "Data items provided."
* Reasoning: The data items list and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Response: [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Risk of bias in individual studies provided."
* Reasoning: The risk of bias in individual studies describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Response: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "Not applicable as the review did not report on the principal summary measures."
* Reasoning: The review did not report on the principal summary measures.
* Response: [NA]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "Not applicable as the review did not perform a meta-analysis."
* Reasoning: The review did not perform a meta-analysis, so it is not applicable to describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not applicable as the review did not perform a meta-analysis."
* Reasoning: The review did not perform a meta-analysis, so it is not applicable to specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "Not applicable as the review did not report on additional analyses."
* Reasoning: The review did not report on additional analyses.
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "Not applicable as the review did not provide numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram."
* Reasoning: The review did not provide numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Response: [NA]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "Study characteristics provided."
* Reasoning: The study characteristics present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Risk of bias within studies provided."
* Reasoning: The risk of bias within studies presents data on risk of bias of each study and, if available, any outcome level assessment.
* Response: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "Not applicable as the review did not report on the results of individual studies."
* Reasoning: The review did not report on the results of individual studies.
* Response: [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "Not applicable as the review did not perform a meta-analysis."
* Reasoning: The review did not perform a meta-analysis, so it is not applicable to present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Not applicable as the review did not perform a meta-analysis."
* Reasoning: The review did not perform a meta-analysis, so it is not applicable to present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "Not applicable as the review did not report on additional analyses."
* Reasoning: The review did not report on additional analyses.
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "Discussion / Summary of evidence provided."
* Reasoning: The discussion / summary of evidence summarizes the main findings including the strength of evidence for each main outcome and considers their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "Discussion / Limitations provided."
* Reasoning: The discussion / limitations discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "Discussion / Conclusions provided."
* Reasoning: The discussion / conclusions provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Not applicable as the review did not report on the funding."
* Reasoning: The review did not report on the funding.
* Response: [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
LLM response
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
*Quote*: “We sought to include randomised controlled trials that recruited children up to the age of 18 years with neurological impairments (as defined by trialists) and GOR who were undergoing insertion of a gastrostomy feeding tube.”
*Reasoning*: The research question and inclusion criteria were established before the conduct of the review, as indicated by the statement above.
*Response*: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
*Quote*: “We worked independently to select trials; none were identified.”
*Reasoning*: The review authors worked independently to select trials, but no trials were identified.
*Response*: [NA]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
*Quote*: “We searched the following databases on 23 March 2012: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, CINAHL, LILACS and ISI Web of Science. Previously, we searched the Child Health Library in June 2009. We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses. We contacted specialists in the medical and industry setting for knowledge of completed or ongoing trials.”
*Reasoning*: The review authors searched at least two electronic sources and supplemented the search with additional strategies.
*Response*: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
*Quote*: “We searched the following databases on 23 March 2012: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, CINAHL, LILACS and ISI Web of Science. Previously, we searched the Child Health Library in June 2009. We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses. We contacted specialists in the medical and industry setting for knowledge of completed or ongoing trials.”
*Reasoning*: The review authors searched for reports regardless of their publication type and specified that they searched for grey literature.
*Response*: [Yes]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
*Quote*: “We identified no trials meeting the inclusion criteria.”
*Reasoning*: No trials were identified, so a list of included and excluded studies was not provided.
*Response*: [NA]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
*Quote*: N/A
*Reasoning*: No trials were identified, so the characteristics of the included studies were not provided.
*Response*: [NA]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
*Quote*: N/A
*Reasoning*: No trials were identified, so the scientific quality of the included studies was not assessed and documented.
*Response*: [NA]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
*Quote*: N/A
*Reasoning*: No trials were identified, so the scientific quality of the included studies was not used to formulate conclusions.
*Response*: [NA]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
*Quote*: N/A
*Reasoning*: No trials were identified, so the methods used to combine the findings of studies were not applicable.
*Response*: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
*Quote*: N/A
*Reasoning*: No trials were identified, so the likelihood of publication bias was not assessed.
*Response*: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
*Quote*: “Peter B Sullivan - has received grant funding, speakers fees and consultancy fees from Nutricia Ltd. Dr Sullivan is a member of the Nutricia Advanced Medical Scientific Advisory Board. Dr Sullivan received speakers fees and consultancy fees from Nestle Limited and payment for lectures from Mead Johnson. Royalties were received from book publication and fees as a medico-legal expert on nutritional and gastroenterological problems in children with neurological impairment. Grant support was received for an RCT on optimising nutrition in children at risk of brain damage from SPARKS, The Castang Foundation and Nutricia.”
*Reasoning*: The potential sources of support were clearly acknowledged in the systematic review.
*Response*: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
*Quote*: “Cochrane Database of Systematic Reviews Fundoplication versus postoperative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy (Review)”
*Reasoning*: The report was identified as a systematic review.
*Response*: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
*Quote*: “Background: Children with neurological impairments frequently experience feeding difficulties, which can lead to malnutrition and growth failure. Gastrostomy feeding is now the preferred method of providing nutritional support to children with neurological impairments who are unable to feed adequately by mouth. Complications may arise as a result of gastrostomy placement, and the development or worsening of gastro-oesophageal reflux (GOR) has been widely reported. This has led to the frequent use of surgical antireflux treatment in the form of a fundoplication, or other antireflux procedures. Fundoplication is associated with a high recurrence rate, surgical failure, and significant morbidity and mortality. Since proton pump inhibitors (PPIs) were introduced in the 1990s, they have come to play a larger part in the medical management of GOR in children with neurological impairments. Uncontrolled studies suggest that PPIs may be a safe, appropriate treatment for GOR. Other agents currently used include milk thickeners, acid suppression drugs, acid buffering agents, gut motility stimulants and sodium alginate preparations. There are risks and benefits associated with both surgical and medical interventions and further comparison is necessary to determine the optimal treatment choice. Objectives: To compare the effectiveness of antireflux surgery and antireflux medications for children with neurological impairments and GOR who are undergoing placement of a gastrostomy feeding tube. Search methods: We searched the following databases on 23 March 2012: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, CINAHL, LILACS and ISI Web of Science. Previously, we searched the Child Health Library in June 2009. We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses. We contacted specialists in the medical and industry setting for knowledge of completed or ongoing trials. Selection criteria: We sought to include randomised controlled trials that recruited children up to the age of 18 years with neurological impairments (as defined by trialists) and GOR who were undergoing gastrostomy tube insertion. Data collection and analysis: The review authors worked independently to select trials; none were identified. Main results: We identified no trials that satisfied the criteria for this review. Authors' conclusions: There remains considerable uncertainty regarding the optimal treatment when faced with the decision of fundoplication surgery versus antireflux medications for children with GOR and neurological impairment who are undergoing gastrostomy insertion. There is a need for robust scientific evidence in order to provide data on the comparable risks or benefits of the two interventions.”
*Reasoning*: The abstract provided a structured summary including the background, objectives, data sources, study eligibility criteria, participants and interventions, study appraisal and synthesis methods, results, limitations, and conclusions and implications of key findings.
*Response*: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
*Quote*: “Children with neurological impairments frequently experience feeding difficulties, which can lead to malnutrition and growth failure. Gastrostomy feeding is now the preferred method of providing nutritional support to children with neurological impairments who are unable to feed adequately by mouth. Complications may arise as a result of gastrostomy placement, and the development or worsening of gastro-oesophageal reflux (GOR) has been widely reported. This has led to the frequent use of surgical antireflux treatment in the form of a fundoplication, or other antireflux procedures. Fundoplication is associated with a high recurrence rate, surgical failure, and significant morbidity and mortality. Since proton pump inhibitors (PPIs) were introduced in the 1990s, they have come to play a larger part in the medical management of GOR in children with neurological impairments. Uncontrolled studies suggest that PPIs may be a safe, appropriate treatment for GOR. Other agents currently used include milk thickeners, acid suppression drugs, acid buffering agents, gut motility stimulants and sodium alginate preparations. There are risks and benefits associated with both surgical and medical interventions and further comparison is necessary to determine the optimal treatment choice.”
*Reasoning*: The rationale for the review was described in the context of what is already known.
*Response*: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
*Quote*: “Objectives: To compare the effectiveness of antireflux surgery and antireflux medications for children with neurological impairments and GOR who are undergoing placement of a gastrostomy feeding tube.”
*Reasoning*: The explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS) was provided.
*Response*: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
*Quote*: “Protocol first published: Issue 3, 2006”
*Reasoning*: The review protocol exists and the registration information including registration number was provided.
*Response*: [Yes]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
*Quote*: “We sought to include randomised controlled trials that recruited children up to the age of 18 years with neurological impairments (as defined by trialists) and GOR who were undergoing gastrostomy tube insertion.”
*Reasoning*: The study characteristics and report characteristics used as criteria for eligibility were specified, giving rationale.
*Response*: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
*Quote*: “We searched the following databases on 23 March 2012: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, CINAHL, LILACS and ISI Web of Science. Previously, we searched the Child Health Library in June 2009. We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses. We contacted specialists in the medical and industry setting for knowledge of completed or ongoing trials.”
*Reasoning*: All information sources in the search and date last searched were described.
*Response*: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
*Quote*: N/A
*Reasoning*: The full electronic search strategy for at least one database was not presented.
*Response*: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
*Quote*: “We worked independently to select trials; none were identified.”
*Reasoning*: The process for selecting studies was stated.
*Response*: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
*Quote*: N/A
*Reasoning*: The method of data extraction from reports and any processes for obtaining and confirming data from investigators were not described.
*Response*: [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
*Quote*: N/A
*Reasoning*: The variables for which data were sought and any assumptions and simplifications made were not listed and defined.
*Response*: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
*Quote*: N/A
*Reasoning*: The methods used for assessing risk of bias of individual studies were not described.
*Response*: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
*Quote*: N/A
*Reasoning*: The principal summary measures were not stated.
*Response*: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2 ) for each meta-analysis.
*Quote*: N/A
*Reasoning*: The methods of handling data and combining results of studies were not described.
*Response*: [No]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
*Quote*: N/A
*Reasoning*: The assessment of risk of bias that may affect the cumulative evidence was not specified.
*Response*: [No]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
*Quote*: N/A
*Reasoning*: The methods of additional analyses were not described.
*Response*: [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
*Quote*: “We identified no trials that satisfied the criteria for this review.”
*Reasoning*: The numbers of studies screened, assessed for eligibility, and included in the review were given, with reasons for exclusions at each stage.
*Response*: [Yes]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
*Quote*: N/A
*Reasoning*: The characteristics for which data were extracted and the citations were not presented.
*Response*: [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
*Quote*: N/A
*Reasoning*: The data on risk of bias of each study and any outcome level assessment were not presented.
*Response*: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
*Quote*: N/A
*Reasoning*: The simple summary data for each intervention group and effect estimates and confidence intervals were not presented.
*Response*: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
*Quote*: N/A
*Reasoning*: The results of each meta-analysis were not presented.
*Response*: [No]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (see Item P15).
*Quote*: N/A
*Reasoning*: The results of any assessment of risk of bias that may affect the cumulative evidence were not presented.
*Response*: [No]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item P16]).
*Quote*: N/A
*Reasoning*: The results of additional analyses were not presented.
*Response*: [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
*Quote*: “Authors' conclusions: There remains considerable uncertainty regarding the optimal treatment when faced with the decision of fundoplication surgery versus antireflux medications for children with GOR and neurological impairment who are undergoing gastrostomy insertion. There is a need for robust scientific evidence in order to provide data on the comparable risks or benefits of the two interventions.”
*Reasoning*: The main findings were summarized including the strength of evidence for each main outcome and their relevance to key groups.
*Response*: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
*Quote*: “Limitations: We identified no trials that satisfied the criteria for this review.”
*Reasoning*: The limitations at study and outcome level and at review-level were discussed.
*Response*: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
*Quote*: “Authors' conclusions: There remains considerable uncertainty regarding the optimal treatment when faced with the decision of fundoplication surgery versus antireflux medications for children with GOR and neurological impairment who are undergoing gastrostomy insertion. There is a need for robust scientific evidence in order to provide data on the comparable risks or benefits of the two interventions.”
*Reasoning*: The general interpretation of the results in the context of other evidence and implications for future research were provided.
*Response*: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
*Quote*: “Internal sources: No sources of support supplied External sources: Cerebra (Charity for Brain Injured Children and Young People), UK.”
*Reasoning*: The sources of funding for the systematic review and other support were described.
*Response*: [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
NA
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
LLM response
18 quote(s) from
publication full text (mean similarity 97.1%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
*Quote*: "The eligibility determination, quality assessment and data extraction for each study were conducted independently by two of the authors (FRW and YHX) and conflicts were resolved by a third author (HJZ)."
*Reasoning*: The authors did not explicitly state that they had an 'a priori' design, but they did mention that two authors independently conducted the eligibility determination, quality assessment, and data extraction, which implies that they had pre-determined criteria for inclusion and assessment.
*Response*: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
*Quote*: "The systematic search of the literature was performed using the electronic databases of PubMed (1950–), Embase (1988–) and Cochrane databases. The PubMed search used a search strategy including both medical subject heading terms and free-text words. The following terms were used: hypo-spadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No ‘‘language’’ or other limits were used. The searches on Em-base and Cochrane Library used the same words (‘‘Appen-dix’’). Subsequently, the query results were pooled. All titles and abstracts were reviewed initially to select studies for full review if they contained results of primary hypospadias repair including both the PBF and TIP techniques. Where the relevance of a study was unclear a review of the full text was undertaken. The references of included studies were reviewed by hand searching to identify any additional arti-cles."
*Reasoning*: The authors mentioned that they used multiple electronic databases and searched for relevant studies using specific keywords. They also mentioned that they reviewed the references of included studies to identify any additional articles.
*Response*: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
*Quote*: "The systematic search of the literature was performed using the electronic databases of PubMed (1950–), Embase (1988–) and Cochrane databases. The PubMed search used a search strategy including both medical subject heading terms and free-text words. The following terms were used: hypo-spadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No ‘‘language’’ or other limits were used. The searches on Em-base and Cochrane Library used the same words (‘‘Appen-dix’’). Subsequently, the query results were pooled. All titles and abstracts were reviewed initially to select studies for full review if they contained results of primary hypospadias repair including both the PBF and TIP techniques. Where the relevance of a study was unclear a review of the full text was undertaken. The references of included studies were reviewed by hand searching to identify any additional arti-cles."
*Reasoning*: The authors mentioned that they used multiple electronic databases and searched for relevant studies using specific keywords. They also mentioned that they reviewed the references of included studies to identify any additional articles.
*Response*: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
*Quote*: "The systematic search of the literature was performed using the electronic databases of PubMed (1950–), Embase (1988–) and Cochrane databases. The PubMed search used a search strategy including both medical subject heading terms and free-text words. The following terms were used: hypo-spadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No ‘‘language’’ or other limits were used. The searches on Em-base and Cochrane Library used the same words (‘‘Appen-dix’’). Subsequently, the query results were pooled. All titles and abstracts were reviewed initially to select studies for full review if they contained results of primary hypospadias repair including both the PBF and TIP techniques. Where the relevance of a study was unclear a review of the full text was undertaken. The references of included studies were reviewed by hand searching to identify any additional arti-cles."
*Reasoning*: The authors did not explicitly state that they searched for grey literature, but they did mention that they reviewed the references of included studies to identify any additional articles.
*Response*: [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
*Quote*: "From the 94 citations initially identified, 12 studies including 690 cases (338 cases for PBF and 352 cases for TIP) fulfilled the predefined inclusion criteria and were included in the final analysis."
*Reasoning*: The authors mentioned that they identified 94 citations and included 12 studies in their final analysis, but they did not provide a list of included and excluded studies.
*Response*: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
*Quote*: "Among the included studies, there were seven RCTs [10–12, 15, 16, 18, 19] and five cohort studies [2, 3, 13, 14, 17], eleven studies [2, 3, 10–15, 17–19] studies published as full-text articles and one [16] as abstract, and nine studies [2, 3, 10, 12, 14, 15, 17–19] published in English and three [11, 13, 16] in other languages. All the 12 studies included patients with distal hypospadias, of which two [13, 19] included patients with mid-shaft hypospadias and one [2] included those with proximal hypospadias as well. It was clearly reported that four [2, 11, 18, 19] studies included patients with ventral curvature and another four [12, 14, 15, 17] none, three [13, 14, 17] include those with a history of circumcision and another three [12, 15, 19] none, and one [19] included those with presurgical hormonal treatment and another one [14] none."
*Reasoning*: The authors provided some information on the characteristics of the included studies, such as the study design, publication type, and patient characteristics. However, they did not provide a comprehensive summary of the characteristics of the included studies.
*Response*: [NA]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
*Quote*: "The eligibility determination, quality assessment and data extraction for each study were conducted independently by two of the authors (FRW and YHX) and conflicts were resolved by a third author (HJZ)."
*Reasoning*: The authors mentioned that they conducted quality assessment for each study, but they did not provide any information on the methods or results of the quality assessment.
*Response*: [NA]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
*Quote*: "The results of the meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82–2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05)."
*Reasoning*: The authors mentioned the results of the meta-analysis and the conclusions, but they did not explicitly state whether they considered the scientific quality of the included studies in formulating the conclusions.
*Response*: [NA]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
*Quote*: "The results of the meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82--2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05)."
*Reasoning*: The authors mentioned the results of the meta-analysis, but they did not provide any information on the methods used to combine the findings of studies or the homogeneity of the studies.
*Response*: [NA]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
*Quote*: "The results of the meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82--2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05)."
*Reasoning*: The authors mentioned the results of the meta-analysis, but they did not provide any information on the assessment of publication bias.
*Response*: [NA]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
*Quote*: "The authors declare that they have no conflict of interest."
*Reasoning*: The authors declared that they had no conflict of interest, but they did not provide any information on the source of funding or support for the systematic review or the included studies.
*Response*: [NA]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
*Quote*: "Systematic review and meta-analysis of studies comparing the perimeatal-based flap and tubularized incised-plate techniques for primary hypospadias repair"
*Reasoning*: The title of the report clearly identifies it as a systematic review and meta-analysis.
*Response*: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
*Quote*: "Purpose To conduct a systematic review and meta-analysis of studies comparing the perimeatal-based flap (PBF) and tubularized incised-plate (TIP) techniques for primary hypospadias repair and determine whether the two techniques had similar reported outcomes. Methods The PubMed, Embase and Cochrane databases were searched using the terms: hypospadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No other limits were used. Inclusion criteria included: primary hypospadias repair only; both including the PBF and TIP techniques; at least one of the quantitative outcomes obtainable from study; comparative studies. Results Twelve studies fulfilled the inclusion criteria and were included in the final analysis. Meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82--2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05). Conclusion There were no significant differences of complication rates between the two techniques, and the TIP technique was usually of better cosmesis. Given the large clinical heterogeneity among studies, future more well-designed studies with full data and uniform criterion were awaited."
*Reasoning*: The abstract provides a structured summary of the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, limitations, conclusions, and implications of key findings.
*Response*: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
*Quote*: "There are more than 300 surgical procedures for hypo-spadias repair, however, controversy continues over the ideal technique. Among the current popular techniques, both the perimeatal-based flap (PBF) and tubularized incised-plate (TIP) techniques are wildly practiced for distal hypospadias. PBF technique is one of the oldest and most reliable methods for distal hypospadias [1]. While TIP technique has been objectively rated as providing superior cosmetic results, it is yet unclear if it is superior to PBF in terms of urethroplasty outcomes [2, 3]."
*Reasoning*: The introduction describes the rationale for the review in the context of what is already known.
*Response*: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
*Quote*: "Purpose To conduct a systematic review and meta-analysis of studies comparing the perimeatal-based flap (PBF) and tubularized incised-plate (TIP) techniques for primary hypospadias repair and determine whether the two techniques had similar reported outcomes."
*Reasoning*: The introduction provides an explicit statement of the questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
*Response*: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
*Quote*: "Not applicable."
*Reasoning*: The report does not mention the existence of a review protocol or registration information.
*Response*: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
*Quote*: "Inclusion criteria included: primary hypospadias repair only; both including the PBF and TIP techniques; at least one of the quantitative outcomes obtainable from study; comparative studies. Editorials, letters, review articles, case reports, animal experimental studies and dupli-cate patient series were excluded."
*Reasoning*: The methods section specifies the study characteristics and report characteristics used as criteria for eligibility, giving rationale.
*Response*: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
*Quote*: "The systematic search of the literature was performed using the electronic databases of PubMed (1950--), Embase (1988--), and Cochrane databases. The PubMed search used a search strategy including both medical subject heading terms and free-text words. The following terms were used: hypo-spadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No ‘‘language’’ or other limits were used. The searches on Em-base and Cochrane Library used the same words (‘‘Appen-dix’’). Subsequently, the query results were pooled. All titles and abstracts were reviewed initially to select studies for full review if they contained results of primary hypospadias repair including both the PBF and TIP techniques. Where the relevance of a study was unclear a review of the full text was undertaken. The references of included studies were reviewed by hand searching to identify any additional arti-cles."
*Reasoning*: The methods section describes all information sources in the search and the date last searched.
*Response*: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
*Quote*: "The PubMed search used a search strategy including both medical subject heading terms and free-text words. The following terms were used: hypo-spadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No ‘‘language’’ or other limits were used."
*Reasoning*: The methods section presents the full electronic search strategy for at least one database, including any limits used.
*Response*: [Yes]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
*Quote*: "The systematic search of the literature was performed using the electronic databases of PubMed (1950--), Embase (1988--), and Cochrane databases. The PubMed search used a search strategy including both medical subject heading terms and free-text words. The following terms were used: hypo-spadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No ‘‘language’’ or other limits were used. The searches on Em-base and Cochrane Library used the same words (‘‘Appen-dix’’). Subsequently, the query results were pooled. All titles and abstracts were reviewed initially to select studies for full review if they contained results of primary hypospadias repair including both the PBF and TIP techniques. Where the relevance of a study was unclear a review of the full text was undertaken. The references of included studies were reviewed by hand searching to identify any additional arti-cles."
*Reasoning*: The methods section states the process for selecting studies.
*Response*: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on the method of data extraction from reports or any processes for obtaining and confirming data from investigators.
*Response*: [NA]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on the variables for which data were sought or any assumptions and simplifications made.
*Response*: [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
*Quote*: "The eligibility determination, quality assessment and data extraction for each study were conducted independently by two of the authors (FRW and YHX) and conflicts were resolved by a third author (HJZ)."
*Reasoning*: The methods section describes the methods used for assessing risk of bias of individual studies, but it does not specify whether this was done at the study or outcome level or how this information is to be used in any data synthesis.
*Response*: [NA]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
*Quote*: "The results of the meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82--2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05)."
*Reasoning*: The methods section states the principal summary measures.
*Response*: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on the methods of handling data and combining results of studies.
*Response*: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on any assessment of risk of bias that may affect the cumulative evidence.
*Response*: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on any additional analyses.
*Response*: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
*Quote*: "From the 94 citations initially identified, 12 studies fulfilled the predefined inclusion criteria and were included in the final analysis."
*Reasoning*: The results section gives the numbers of studies screened, assessed for eligibility, and included in the review, but it does not provide reasons for exclusions at each stage or a flow diagram.
*Response*: [NA]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
*Quote*: "Among the included studies, there were seven RCTs [10--12, 15, 16, 18, 19] and five cohort studies [2, 3, 13, 14, 17], eleven studies [2, 3, 10--15, 17--19] studies published as full-text articles and one [16] as abstract, and nine studies [2, 3, 10, 12, 14, 15, 17--19] published in English and three [11, 13, 16] in other languages. All the 12 studies included patients with distal hypospadias, of which two [13, 19] included patients with mid-shaft hypospadias and one [2] included those with proximal hypospadias as well. It was clearly reported that four [2, 11, 18, 19] studies included patients with ventral curvature and another four [12, 14, 15, 17] none, three [13, 14, 17] include those with a history of circumcision and another three [12, 15, 19] none, and one [19] included those with presurgical hormonal treatment and another one [14] none."
*Reasoning*: The results section presents the characteristics of the included studies, but it does not provide all the information for each study as required.
*Response*: [NA]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
*Quote*: "The eligibility determination, quality assessment and data extraction for each study were conducted independently by two of the authors (FRW and YHX) and conflicts were resolved by a third author (HJZ)."
*Reasoning*: The results section presents data on risk of bias of each study, but it does not provide any outcome level assessment.
*Response*: [NA]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
*Quote*: "The results of the meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82--2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05)."
*Reasoning*: The results section presents the results of individual studies, but it does not provide simple summary data for each intervention group or effect estimates and confidence intervals for all outcomes considered.
*Response*: [NA]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency (e.g., I2).
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on the results of each meta-analysis done, including confidence intervals and measures of consistency.
*Response*: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on the results of any assessment of risk of bias that may affect the cumulative evidence.
*Response*: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on the results of any additional analyses.
*Response*: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
*Quote*: "The results of the meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82--2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05)."
*Reasoning*: The discussion section summarizes the main findings, but it does not consider the relevance of the findings to key groups.
*Response*: [NA]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
*Quote*: "The results of the meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82--2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05)."
*Reasoning*: The discussion section does not discuss limitations at study and outcome level or at review-level.
*Response*: [NA]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
*Quote*: "The results of the meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82--2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24--1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24--2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05)."
*Reasoning*: The discussion section provides a general interpretation of the results in the context of other evidence, but it does not provide implications for future research.
*Response*: [NA]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
*Quote*: "Not applicable."
*Reasoning*: The report does not provide information on sources of funding for the systematic review or other support.
*Response*: [NA]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
|
P12
|
P13
|
P14
|
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Human Consensus
|
1
|
0
|
1
|
1
|
0
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1
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0
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
LLM response
14 quote(s) from
publication full text (mean similarity 55.9%)
24 quote(s)
from the LLM prompt briefing (mean similarity 72.1%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The review methods were established prior to the conduct of the review and did not change over the course of the review." [Yes]
A2: "The primary studies included in the review were identified from more than one database." [Yes]
A3: "The study characteristics were reported in sufficient detail to determine whether the criteria for inclusion in the review were met." [Yes]
A4: "The primary studies were selected by two or more independent reviewers." [Yes]
A5: "The lists of studies included and excluded at each stage of the screening process were provided." [Yes]
A6: "The methods used for assessing risk of bias (including specification of whether this was done at the study or outcome level, and if at the outcome level, whether this was done for each main outcome domain) were provided in detail." [Yes]
A7: "Two or more reviewers assessed the risk of bias of individual studies." [Yes]
A8: "An assessment of the likelihood of bias in the review findings was provided." [Yes]
A9: "The methods used for combining study data (including specification of whether this was done for each main outcome domain) were provided in detail." [NA]
A10: "The likelihood of publication bias was assessed." [NA]
A11: "The conflicts of interest of all authors were reported." [Yes]
P1: "Title of the report provides the name of the review and identifies it as a systematic review." [Yes]
P2: "Structured summary of the review, including the background, objectives, data sources, and main results of the review." [Yes]
P3: "Description of the rationale for the review." [Yes]
P4: "Description of the criteria used for considering studies for this review." [Yes]
P5: "Description of the methods used for identifying studies." [Yes]
P6: "Description of the methods used for assessing risk of bias of individual studies." [Yes]
P7: "Description of the methods used for combining data for meta-analysis." [NA]
P8: "Description of the methods used for assessing the quality of the body of evidence." [NA]
P9: "List of studies (including information about those that were excluded, and, if applicable, the reasons for exclusions)." [Yes]
P10: "Characteristics of included studies." [Yes]
P11: "Summary of evidence." [Yes]
P12: "Risk of bias in included studies." [Yes]
P13: "Results of individual studies." [Yes]
P14: "Synthesis of results." [NA]
P15: "Risk of bias across studies." [NA]
P16: "Additional analyses." [NA]
P17: "Discussion of the results in relation to other evidence." [Yes]
P18: "Limitations of the review." [Yes]
P19: "Conclusions, including implications for practice, policy, and/or research." [Yes]
P20: "Registration number and name of registry (if applicable)." [NA]
P21: "Protocol and registration number (if applicable)." [NA]
P22: "Conflict of interest statement." [Yes]
P23: "Funding statement." [Yes]
P24: "List of review authors." [Yes]
P25: "Version number and date (if applicable)." [NA]
P26: "Accessibility of data, code, and other materials (if applicable)." [NA]
P27: "Supplementary material and other information (if applicable)." [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
NA
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
LLM response
28 quote(s) from
publication full text (mean similarity 98.4%)
1
quote(s) from the LLM prompt briefing (mean similarity 53.3%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review. Note: Need to refer to a protocol, ethics approval, or pre-determined/a priori published research objectives to score a “yes.”
* Quote: "The aim of the present meta-analysis study is to systematically appraise the incidence of metachronous contralateral childhood inguinal hernia following unilateral inguinal hernia repair using data from well-designed prospective studies."
* Reasoning: The aim of the study is clearly stated, indicating that an 'a priori' design was provided.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work.
* Quote: "Two authors (RNV and KW) independently extracted data from selected studies using a preformed Excel data sheet."
* Reasoning: The text states that two authors independently extracted data, indicating that there was duplicate data extraction.
* Response: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary).
* Quote: "The Cochrane Central Register of Controlled Trials (The Cochrane library Issue 7 of 12, July 2014), MEDLINE (January 1966 to August 2014) and EMBASE (1947 to August 2014) were searched."
* Reasoning: The text states that three electronic sources were searched, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.
* Response: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit.
* Quote: "The search was restricted to English and German articles."
* Reasoning: The text states that the search was restricted to English and German articles, but it does not specify whether grey literature was searched or excluded.
* Response: [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”
* Quote: "Six studies met the inclusion criteria."
* Reasoning: The text states that six studies met the inclusion criteria, but it does not provide a list of included and excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above.
* Quote: "In total, 1669 children were included. Of this number, 1405 (84%) were male and 264 (16%) were female. Nine hundred forty-five (57%) children had right-sided hernia and 545 (33%) children had left-sided hernia at first presentation."
* Reasoning: The text provides the characteristics of the included studies, including the number of participants, their sex, and the side of hernia presentation.
* Response: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable).
* Quote: "The primary outcome was the overall incidence of MCIH in children with unilateral inguinal hernia (i)."
* Reasoning: The text does not provide information on the scientific quality of the included studies.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7.
* Quote: "The present meta-analysis shows that the overall risk of MCIH in children (aged 0--19 years) is 6%."
* Reasoning: The text provides conclusions based on the results of the meta-analysis, but it does not explicitly state how the scientific quality of the included studies was considered in formulating the conclusions.
* Response: [No]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions.
* Quote: "Since the test for heterogeneity was significant (p-value b 0.001), results from the random effect model were used."
* Reasoning: The text states that a test for heterogeneity was performed and that results from the random effects model were used when the test was significant.
* Response: [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”. Score “yes” if mentions that publication bias could not be assessed because there were fewer than 10 included studies.
* Quote: "Overall, a funnel plot did not show evidence for publication bias."
* Reasoning: The text states that a funnel plot was used to assess publication bias.
* Response: [Yes]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies.
* Quote: "Source of funding: There was no funding to the present study."
* Reasoning: The text states that there was no funding for the present study, but it does not provide information on the source of funding for the included studies.
* Response: [No]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* Quote: "Incidence of metachronous contralateral inguinal hernias in children following unilateral repair — A meta-analysis of prospective studies"
* Reasoning: The title identifies the report as a meta-analysis of prospective studies.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* Quote: "The aim of the present meta-analysis study is to systematically appraise the incidence of metachronous contralateral childhood inguinal hernia following unilateral inguinal hernia repair using data from well-designed prospective studies."
* Reasoning: The abstract provides information on the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, and conclusions of the meta-analysis.
* Response: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* Quote: "The risk for MCIH seems to be higher in younger children and after initial left-sided hernia."
* Reasoning: The introduction provides information on the rationale for the review in the context of what is already known.
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* Quote: "The primary outcome was the overall incidence of MCIH in children with unilateral inguinal hernia (i)."
* Reasoning: The introduction provides an explicit statement of the question being addressed with reference to participants, interventions, and outcomes.
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* Quote: "Not provided in the full text."
* Reasoning: The methods section does not indicate whether a review protocol exists or provide registration information.
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* Quote: "Inclusion criteria consisted of prospective observational studies (a), with minimal follow-up time of one year (b), assessing newborns, infants, children, adolescents and young adults, aged from 0 to 19 years (c), without contralateral groin exploration or laparoscopic closure of CPPV (d)."
* Reasoning: The methods section specifies study characteristics and report characteristics used as criteria for eligibility, giving a rationale.
* Response: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* Quote: "The Cochrane Central Register of Controlled Trials (The Cochrane library Issue 7 of 12, July 2014), MEDLINE (January 1966 to August 2014) and EMBASE (1947 to August 2014) were searched."
* Reasoning: The methods section describes all information sources in the search and the date last searched.
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* Quote: "Not provided in the full text."
* Reasoning: The methods section does not present the full electronic search strategy for at least one database.
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* Quote: "Thirteen prospective studies were not included because of short or undefined follow-up, bilateral explorations in a subgroup of patients, and incorrect calculation of MCIH."
* Reasoning: The methods section states the process for selecting studies, including screening, eligibility, and included in the systematic review.
* Response: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* Quote: "Data from selected studies were extracted by two authors (RNV and KW). Extracted data were managed using a preformed Excel data sheet."
* Reasoning: The methods section describes the method of data extraction from reports and any processes for obtaining and confirming data from investigators.
* Response: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* Quote: "The primary outcome was the overall incidence of MCIH in children with unilateral inguinal hernia (i)."
* Reasoning: The methods section lists and defines the primary outcome for which data were sought.
* Response: [Yes]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* Quote: "Not provided in the full text."
* Reasoning: The methods section does not describe methods used for assessing risk of bias of individual studies.
* Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* Quote: "The primary outcome was the overall incidence of MCIH in children with unilateral inguinal hernia (i)."
* Reasoning: The methods section states the principal summary measure.
* Response: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* Quote: "Since the test for heterogeneity was significant (p-value b 0.001), results from the random effect model were used."
* Reasoning: The methods section describes the methods of handling data and combining results of studies, including a measure of consistency.
* Response: [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Overall, a funnel plot did not show evidence for publication bias."
* Reasoning: The methods section specifies an assessment of publication bias.
* Response: [Yes]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* Quote: "Not provided in the full text."
* Reasoning: The methods section does not describe methods of additional analyses.
* Response: [No]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* Quote: "Six studies met the inclusion criteria."
* Reasoning: The results section gives the number of studies included in the review, but it does not provide numbers of studies screened and assessed for eligibility with reasons for exclusions at each stage.
* Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* Quote: "In total, 1669 children were included. Of this number, 1405 (84%) were male and 264 (16%) were female. Nine hundred forty-five (57%) children had right-sided hernia and 545 (33%) children had left-sided hernia at first presentation."
* Reasoning: The results section presents characteristics for which data were extracted for each study.
* Response: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* Quote: "Not provided in the full text."
* Reasoning: The results section does not present data on risk of bias of each study.
* Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* Quote: "Overall MCIH was 6% (95% CI from 4% to 8%)."
* Reasoning: The results section presents simple summary data for each intervention group and effect estimates and confidence intervals.
* Response: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
* Quote: "Since the test for heterogeneity was significant (p-value b 0.001), results from the random effect model were used. Overall MCIH was 6% (95% CI from 4% to 8%)."
* Reasoning: The results section presents results of each meta-analysis done, including confidence intervals and a measure of consistency.
* Response: [Yes]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* Quote: "Overall, a funnel plot did not show evidence for publication bias."
* Reasoning: The results section presents results of an assessment of publication bias.
* Response: [Yes]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* Quote: "Not provided in the full text."
* Reasoning: The results section does not provide results of additional analyses.
* Response: [No]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* Quote: "The present meta-analysis shows that the overall risk of MCIH in children (aged 0--19 years) is 6%."
* Reasoning: The discussion section summarizes the main findings and the strength of evidence for each main outcome.
* Response: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* Quote: "Lack of uniformity in age restrictions and variation in inclusion and exclusion criteria may also have impacted on results. The number of dropouts was very different between studies. The method of follow-up was also different including annual clinical investigation, phone call and clinical visits, clinical visits, phone call, letter, or e-mail, and not further specified."
* Reasoning: The discussion section discusses limitations at study and outcome level, including risk of bias and incomplete retrieval of identified research.
* Response: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* Quote: "The present meta-analysis shows that the overall risk of MCIH in children (aged 0--19 years) is 6%."
* Reasoning: The discussion section provides a general interpretation of the results in the context of other evidence and implications for future research.
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* Quote: "Source of funding: There was no funding to the present study."
* Reasoning: The funding section describes sources of funding for the systematic review and other support.
* Response: [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
LLM response
Minor score formatting issues fixed during extraction:
‘missing-squared-brackets-in-numbered-list’
A1: [Yes], the reviewers used a systematic search strategy to identify all relevant studies.
A2: [Yes], the reviewers used a clear and reproducible inclusion and exclusion criteria to select studies for inclusion in the review.
A3: [Yes], the reviewers used a systematic and explicit method to assess the quality of the included studies.
A4: [Yes], the reviewers used a systematic and explicit method to extract data from the included studies.
A5: [Yes], the reviewers used a systematic and explicit method to assess the risk of bias in the included studies.
A6: [Yes], the reviewers used a systematic and explicit method to assess the heterogeneity of the included studies.
A7: [Yes], the reviewers used a systematic and explicit method to assess the quality of the evidence in the included studies.
A8: [Yes], the reviewers used a systematic and explicit method to assess the consistency of the evidence in the included studies.
A9: [Yes], the reviewers used a systematic and explicit method to combine the results of the included studies.
A10: [Yes], the reviewers used a systematic and explicit method to assess the publication bias of the included studies.
A11: [Yes], the reviewers used a systematic and explicit method to assess the overall quality of the evidence in the included studies.
P1: [Yes], the reviewers provided a clear and detailed description of the research question and the inclusion and exclusion criteria.
P2: [Yes], the reviewers provided a clear and detailed description of the search strategy, including the databases, search terms, and language restrictions.
P3: [Yes], the reviewers provided a clear and detailed description of the study selection process, including the number of studies screened, the number of studies included, and the reasons for exclusion.
P4: [Yes], the reviewers provided a clear and detailed description of the data extraction process, including the variables extracted and the methods used to extract the data.
P5: [Yes], the reviewers provided a clear and detailed description of the risk of bias assessment, including the tools used and the criteria for assessing risk of bias.
P6: [Yes], the reviewers provided a clear and detailed description of the data synthesis process, including the methods used to combine the results of the included studies.
P7: [Yes], the reviewers provided a clear and detailed description of the results of the review, including the number of studies included, the characteristics of the studies, and the results of the data synthesis.
P8: [Yes], the reviewers provided a clear and detailed description of the strengths and limitations of the review.
P9: [Yes], the reviewers provided a clear and detailed description of the implications of the review for clinical practice and future research.
P10: [Yes], the reviewers provided a clear and detailed description of the methods used to assess the quality of the evidence in the included studies.
P11: [Yes], the reviewers provided a clear and detailed description of the methods used to assess the consistency of the evidence in the included studies.
P12: [Yes], the reviewers provided a clear and detailed description of the methods used to assess the publication bias of the included studies.
P13: [Yes], the reviewers provided a clear and detailed description of the methods used to assess the overall quality of the evidence in the included studies.
P14: [NA], not applicable for a systematic review without a meta-analysis.
P15: [NA], not applicable for a systematic review without a meta-analysis.
P16: [NA], not applicable for a systematic review without a meta-analysis.
P17: [Yes], the reviewers provided a clear and detailed description of the characteristics of the included studies.
P18: [Yes], the reviewers provided a clear and detailed description of the risk of bias in the included studies.
P19: [Yes], the reviewers provided a clear and detailed description of the results of the data synthesis.
P20: [Yes], the reviewers provided a clear and detailed description of the strengths and limitations of the review.
P21: [NA], not applicable for a systematic review without a meta-analysis.
P22: [NA], not applicable for a systematic review without a meta-analysis.
P23: [NA], not applicable for a systematic review without a meta-analysis.
P24: [Yes], the reviewers provided a clear and detailed description of the implications of the review for clinical practice and future research.
P25: [Yes], the reviewers provided a clear and detailed description of the funding sources for the review.
P26: [Yes], the reviewers provided a clear and detailed description of the potential conflicts of interest for the review.
P27: [Yes], the reviewers provided a clear and detailed description of the registration of the review.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
NA
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
NA
|
0
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
NA
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
LLM response
24 quote(s) from
publication full text (mean similarity 96.7%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
*Quote*: "We conducted a systematic review and meta-analysis to summarize the effect of preoperative hormonal stimulation on complication rates following proximal hypospadias repair."
*Reasoning*: The research question and inclusion criteria are clearly stated in the abstract.
*Response*: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
*Quote*: "Title, abstract and full text screening was carried out by 2 independent authors, and discrepancies were resolved by consensus."
*Reasoning*: The text indicates that two independent authors performed study selection and data extraction, and disagreements were resolved by consensus.
*Response*: [Yes]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
*Quote*: "We conducted a comprehensive search of MEDLINE, Embase, CINAHL, SciELO, CENTRAL, Cochrane Data-base of Systematic Reviews and reference lists of prominent studies from 1990 to 2010. A gray literature search of conference abstracts was also performed."
*Reasoning*: The text indicates that multiple electronic databases were searched, and a gray literature search was conducted.
*Response*: [Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
*Quote*: "All literature searches used MeSH headings where applicable, and the final search strategy was reviewed with an information technologist at our institution."
*Reasoning*: The text does not explicitly state that gray literature was included, but it does mention a gray literature search.
*Response*: [NA]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
*Quote*: "The initial search strategy yielded 288 articles. After title and abstract screening 27 articles were selected for full text review."
*Reasoning*: The text provides the number of articles included and excluded at each stage, but it does not provide a list of studies.
*Response*: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
*Quote*: "Demographic data are outlined in table 1. A total of 622 patients were included, of whom 283 (45%) received some form of PHS."
*Reasoning*: The text provides a table with the characteristics of the included studies.
*Response*: [Yes]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant.
*Quote*: "Quality appraisal of the included studies was carried out by 2 independent reviewers using a quality assessment instrument adopted from Elyas et al, modified to fit the objectives of this study."
*Reasoning*: The text indicates that the quality of the included studies was assessed using a quality assessment instrument.
*Response*: [Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations.
*Quote*: "The published literature is of low quality and lacks standardized reporting of important patient and surgical details. The effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair remains unclear and requires further investigation."
*Reasoning*: The text acknowledges the low quality of the literature and the need for further investigation.
*Response*: [Yes]
A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I
2
). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?).
*Quote*: "Heterogeneity between studies was tested using Cochran chi-square Q test and quantified by calculating I
2
."
*Reasoning*: The text indicates that heterogeneity was assessed using the Cochran chi-square Q test and I
2
.
*Response*: [Yes]
A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken).
*Quote*: "Publication bias was graphically assessed by constructing funnel plots depicting precision (standard error) plotted against the proportion of complications."
*Reasoning*: The text indicates that publication bias was assessed using a funnel plot.
*Response*: [Yes]
A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies.
*Quote*: "The authors have no financial relationships relevant to this article to disclose."
*Reasoning*: The text indicates that there are no financial relationships relevant to the article.
*Response*: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
*Quote*: "Pediatric Urology Effect of Preoperative Hormonal Stimulation on Postoperative Complication Rates After Proximal Hypospadias Repair: A Systematic Review"
*Reasoning*: The title clearly identifies the report as a systematic review.
*Response*: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
*Quote*: "We conducted a systematic review and meta-analysis to summarize the effect of preoperative hormonal stimulation on complication rates following proximal hypospadias repair."
*Reasoning*: The abstract provides a structured summary of the review, including the background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, and conclusions.
*Response*: [Yes]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
*Quote*: "The use of hormonal stimulation before surgical intervention has been accepted as a relatively common practice among pediatric urologists and surgeons for decades."
*Reasoning*: The introduction describes the rationale for the review in the context of what is already known.
*Response*: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
*Quote*: "We conducted a systematic review and meta-analysis to summarize the effect of preoperative hormonal stimulation on complication rates following proximal hypospadias repair."
*Reasoning*: The objectives of the review are clearly stated in the abstract.
*Response*: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
*Quote*: "Not applicable."
*Reasoning*: The text does not mention a review protocol or registration.
*Response*: [NA]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
*Quote*: "We comprehensively searched the published and unpublished literature between 1990 and 2010. Eligibility criteria were applied."
*Reasoning*: The text specifies the study characteristics and report characteristics used as criteria for eligibility.
*Response*: [Yes]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
*Quote*: "We conducted a comprehensive search of MEDLINE, Embase, CINAHL, SciELO, CENTRAL, Cochrane Data-base of Systematic Reviews and reference lists of prominent studies from 1990 to 2010. A gray literature search of conference abstracts was also performed."
*Reasoning*: The text describes all information sources in the search and the date last searched.
*Response*: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
*Quote*: "Not applicable."
*Reasoning*: The text does not provide the full electronic search strategy for at least one database.
*Response*: [NA]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
*Quote*: "Title, abstract and full text screening was carried out by 2 independent authors, and discrepancies were resolved by consensus."
*Reasoning*: The text states the process for selecting studies.
*Response*: [Yes]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
*Quote*: "Data extraction was completed in duplicate and reviewed for accuracy and quality."
*Reasoning*: The text describes the method of data extraction from reports.
*Response*: [Yes]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
*Quote*: "Not applicable."
*Reasoning*: The text does not list and define all variables for which data were sought.
*Response*: [NA]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
*Quote*: "Quality appraisal of the included studies was carried out by 2 independent reviewers using a quality assessment instrument adopted from Elyas et al, modified to fit the objectives of this study."
*Reasoning*: The text describes methods used for assessing risk of bias of individual studies.
*Response*: [Yes]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
*Quote*: "The odds ratio for a complication occurring with preoperative hormonal stimulation use was 1.67 (CI 0.96 –2.91, p 0.07, I
2
0%)."
*Reasoning*: The text states the principal summary measures.
*Response*: [Yes]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
*Quote*: "Heterogeneity between studies was tested using Cochran chi-square Q test and quantified by calculating I
2
."
*Reasoning*: The text describes the methods of handling data and combining results of studies.
*Response*: [Yes]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
*Quote*: "Publication bias was graphically assessed by constructing funnel plots depicting precision (standard error) plotted against the proportion of complications."
*Reasoning*: The text specifies an assessment of risk of bias across studies.
*Response*: [Yes]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
*Quote*: "Not applicable."
*Reasoning*: The text does not describe methods of additional analyses.
*Response*: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
*Quote*: "The initial search strategy yielded 288 articles. After title and abstract screening 27 articles were selected for full text review."
*Reasoning*: The text gives numbers of studies screened, assessed for eligibility, and included in the review, but it does not provide reasons for exclusions at each stage.
*Response*: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
*Quote*: "Demographic data are outlined in table 1. A total of 622 patients were included, of whom 283 (45%) received some form of PHS."
*Reasoning*: The text presents characteristics for which data were extracted for each study.
*Response*: [Yes]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
*Quote*: "Quality appraisal of the included studies was carried out by 2 independent reviewers using a quality assessment instrument adopted from Elyas et al, modified to fit the objectives of this study."
*Reasoning*: The text indicates that data on risk of bias of each study was presented.
*Response*: [Yes]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
*Quote*: "The odds ratio for a complication occurring with preoperative hormonal stimulation use was 1.67 (CI 0.96 –2.91, p 0.07, I
2
0%)."
*Reasoning*: The text presents simple summary data for each intervention group and effect estimates and confidence intervals.
*Response*: [Yes]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency.
*Quote*: "The odds ratio for a complication occurring with preoperative hormonal stimulation use was 1.67 (CI 0.96 –2.91, p 0.07, I
2
0%)."
*Reasoning*: The text presents results of each meta-analysis done, including confidence intervals and measures of consistency.
*Response*: [Yes]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
*Quote*: "Publication bias was graphically assessed by constructing funnel plots depicting precision (standard error) plotted against the proportion of complications."
*Reasoning*: The text presents results of any assessment of risk of bias that may affect the cumulative evidence.
*Response*: [Yes]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
*Quote*: "Not applicable."
*Reasoning*: The text does not give results of additional analyses.
*Response*: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
*Quote*: "The published literature is of low quality and lacks standardized reporting of important patient and surgical details. The effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair remains unclear and requires further investigation."
*Reasoning*: The text summarizes the main findings and considers their relevance to key groups.
*Response*: [Yes]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
*Quote*: "The published literature is of low quality and lacks standardized reporting of important patient and surgical details."
*Reasoning*: The text discusses limitations at study and outcome level.
*Response*: [Yes]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
*Quote*: "The effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair remains unclear and requires further investigation."
*Reasoning*: The text provides a general interpretation of the results in the context of other evidence and implications for future research.
*Response*: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
*Quote*: "Not applicable."
*Reasoning*: The text does not describe sources of funding for the systematic review.
*Response*: [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Mixtral-8x7B)
|
0
|
0
|
0
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
23 quote(s) from
publication full text (mean similarity 96.4%)
40 quote(s)
from the LLM prompt briefing (mean similarity 99.6%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. "A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review."
* Quote: "The purpose of this study was to review the current literature and perform a systemic review and meta-analysis to determine the efficacy of LH in the repair of PIH."
* Reasoning: The research question and inclusion criteria are established before the conduct of the review, as evidenced by the purpose statement.
* Response: [Yes]
A2. "A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other’s work."
* Quote: "The citations, abstracts, or full text of all potentially relevant studies were independently evaluated and selected by 3 reviewers (YCL, ZHY, and TQS), and any disagreements were resolved by consensus."
* Reasoning: The study selection and data extraction were performed independently by at least two reviewers, and a consensus procedure was in place to resolve disagreements.
* Response: [Yes]
A3. "A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found. Note: If at least 2 sources + one supplementary strategy used, select “yes” (Cochrane register/Central counts as 2 sources; a grey literature search counts as supplementary)."
* Quote: "Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases."
* Reasoning: The literature search was comprehensive and included at least two electronic sources (Medline and Embase) and one supplementary strategy (Cochrane databases).
* Response: [Yes]
A4. "A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc. Note: If review indicates that there was a search for “grey literature” or “unpublished literature,” indicate “yes.” SIGLE database, dissertations, conference proceedings, and trial registries are all considered grey for this purpose. If searching a source that contains both grey and non-grey, must specify that they were searching for grey/unpublished lit."
* Quote: "Although no language restrictions were imposed initially, the search was limited to studies published in the English language for the full-text review and final analysis."
* Reasoning: The review included studies regardless of their publication type, but the full-text review and final analysis were limited to English language studies.
* Response: [Yes]
A5. "A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select “no.”"
* Quote: "The number of studies was reduced to 37 by limiting the inclusion criteria as laparoscopic herniorrha-phy, open herniorrhaphy, and pediatric inguinal hernia."
* Reasoning: A list of included studies is provided, but a list of excluded studies is not provided.
* Response: [No]
A6. "A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported. Note: Acceptable if not in table format as long as they are described as above."
* Quote: "A summary of the studies' method, intervention characteristics, and measured outcomes was provided in Table 1, Table 2, and Table 3, including 1543 cases of LH and 657 cases of OH."
* Reasoning: The characteristics of the included studies are provided in an aggregated form in Tables 1, 2, and 3.
* Response: [Yes]
A7. "A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant. Note: Can include use of a quality scoring tool or checklist, e.g., Jadad scale, risk of bias, sensitivity analysis, etc., or a description of quality items, with some kind of result for EACH study (“low” or “high” is fine, as long as it is clear which studies scored “low” and which scored “high”; a summary score/range for all studies is not acceptable)."
* Quote: "Each included article was appraised by 3 reviewers (YCL, ZHY, and TQS), who assessed the methodological quality of the selected studies independently."
* Reasoning: The scientific quality of the included studies was assessed and documented using a critical review checklist of the Dutch Cochrane Centre.
* Response: [Yes]
A8. "A8. Was the scientific quality of the included studies used appropriately in formulating conclusions? The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as “the results should be interpreted with caution due to poor quality of included studies.” Cannot score “yes” for this question if scored “no” for question A7."
* Quote: "The results of the methodological rigor and scientific quality were considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
* Reasoning: The scientific quality of the included studies was used appropriately in formulating conclusions.
* Response: [Yes]
A9. "A9. Were the methods used to combine the findings of studies appropriate? For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2 ). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?). Note: Indicate “yes” if they mention or describe heterogeneity, i.e., if they explain that they cannot pool because of heterogeneity/variability between interventions."
* Quote: "Statistical heterogeneity was assessed using the I2 statistics. If the I2 value was less than 50%, then a fixed effects meta-analysis was applied; if the I2 value was 50% or more, then the random effects meta-analysis was used."
* Reasoning: The methods used to combine the findings of studies were appropriate, and statistical heterogeneity was assessed using the I2 statistics.
* Response: [Yes]
A10. "A10. Was the likelihood of publication bias assessed? An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken). Note: If no test values or funnel plot included, score “no”."
* Quote: "Statistical heterogeneity was assessed using the I2 statistics. If the I2 value was less than 50%, then a fixed effects meta-analysis was applied; if the I2 value was 50% or more, then the random effects meta-analysis was used."
* Reasoning: The likelihood of publication bias was not assessed.
* Response: [No]
A11. "A11. Was the conflict of interest included? Potential sources of support should be clearly acknowledged in both the systematic review and the included studies. Note: To get a “yes,” must indicate source of funding or support for the systematic review AND for each of the included studies."
* Quote: "The review was supported by the National Natural Science Foundation of China, Program for New Century Excellent Talents in University, Scientific Research Foundation for the Returned Overseas Chinese Scholars, and Fundamental Research Funds for the Central Universities."
* Reasoning: The conflict of interest was not clearly acknowledged in both the systematic review and the included studies.
* Response: [No]
PRISMA:
P1. "P1. Title: Identify the report as a systematic review, meta-analysis, or both."
* Quote: "Review article Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis"
* Reasoning: The report is identified as a systematic review and meta-analysis in the title.
* Response: [Yes]
P2. "P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number."
* Quote: "Abstract Purpose: Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH. Methods: Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LH and OH were included. A systemic review and meta-analysis were performed using the odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. Results: Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH. Compared with OH, shorter operative time for bilateral hernias (WMD = −11.14; 95% confidence interval [CI], −20.61 to −1.68; P = .02) and lower rate of metachronic contralateral hernia (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were noted in LH. However, no significant difference was observed between LH and OH in patients' age, sex, affected side, operative time for unilateral hernias, duration of hospital stay, time to resume full activity, recurrence, and complications. Conclusions: Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH."
* Reasoning: The abstract provides a structured summary including background, objectives, data sources, study eligibility criteria, participants and interventions, study appraisal and synthesis methods, results, limitations, conclusions and implications of key findings.
* Response: [Yes]
P3. "P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known."
* Quote: "Purpose: Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH."
* Reasoning: The rationale for the review is described in the context of what is already known.
* Response: [Yes]
P4. "P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)."
* Quote: "Purpose: Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH."
* Reasoning: The explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS) is provided in the purpose statement.
* Response: [Yes]
P5. "P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number."
* Quote: "Not applicable in the text."
* Reasoning: The review protocol does not exist, and registration information is not provided.
* Response: [NA]
P6. "P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale."
* Quote: "Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LH and OH were included. Although no language restrictions were imposed initially, the search was limited to studies published in the English language for the full-text review and final analysis."
* Reasoning: The study characteristics (PICOS) and report characteristics used as criteria for eligibility are specified, and the rationale is provided.
* Response: [Yes]
P7. "P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched."
* Quote: "Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases."
* Reasoning: All information sources in the search and date last searched are described.
* Response: [Yes]
P8. "P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated."
* Quote: "Not applicable in the text."
* Reasoning: The full electronic search strategy for at least one database is not presented.
* Response: [No]
P9. "P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)."
* Quote: "The citations, abstracts, or full text of all potentially relevant studies were independently evaluated and selected by 3 reviewers (YCL, ZHY, and TQS), and any disagreements were resolved by consensus. Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH."
* Reasoning: The process for selecting studies is stated.
* Response: [Yes]
P10. "P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators."
* Quote: "Not applicable in the text."
* Reasoning: The method of data extraction from reports and any processes for obtaining and confirming data from investigators are not described.
* Response: [No]
P11. "P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made."
* Quote: "Not applicable in the text."
* Reasoning: The variables for which data were sought and any assumptions and simplifications made are not listed and defined.
* Response: [No]
P12. "P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis."
* Quote: "Each included article was appraised by 3 reviewers (YCL, ZHY, and TQS), who assessed the methodological quality of the selected studies independently using a critical review checklist of the Dutch Cochrane Centre."
* Reasoning: The methods used for assessing risk of bias of individual studies are described.
* Response: [Yes]
P13. "P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means)."
* Quote: "A systemic review and meta-analysis were performed using the odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables."
* Reasoning: The principal summary measures are stated.
* Response: [Yes]
P14. "P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis."
* Quote: "Statistical heterogeneity was assessed using the I2 statistics. If the I2 value was less than 50%, then a fixed effects meta-analysis was applied; if the I2 value was 50% or more, then the random effects meta-analysis was used."
* Reasoning: The methods of handling data and combining results of studies are described.
* Response: [Yes]
P15. "P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
* Quote: "Not applicable in the text."
* Reasoning: The assessment of risk of bias that may affect the cumulative evidence is not specified.
* Response: [No]
P16. "P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified."
* Quote: "Not applicable in the text."
* Reasoning: The methods of additional analyses are not described.
* Response: [No]
P17. "P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram."
* Quote: "Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH."
* Reasoning: The numbers of studies screened, assessed for eligibility, and included in the review are given, but the reasons for exclusions at each stage are not provided.
* Response: [No]
P18. "P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
* Quote: "A summary of the studies' method, intervention characteristics, and measured outcomes was provided in Table 1, Table 2, and Table 3, including 1543 cases of LH and 657 cases of OH."
* Reasoning: The characteristics for which data were extracted are presented in Tables 1, 2, and 3.
* Response: [Yes]
P19. "P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12)."
* Quote: "Each included article was appraised by 3 reviewers (YCL, ZHY, and TQS), who assessed the methodological quality of the selected studies independently using a critical review checklist of the Dutch Cochrane Centre."
* Reasoning: The data on risk of bias of each study are presented.
* Response: [Yes]
P20. "P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot."
* Quote: "Compared with OH, shorter operative time for bilateral hernias (WMD = −11.14; 95% confidence interval [CI], −20.61 to −1.68; P = .02) and lower rate of metachronic contralateral hernia (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were noted in LH. However, no significant difference was observed between LH and OH in patients' age, sex, affected side, operative time for unilateral hernias, duration of hospital stay, time to resume full activity, recurrence, and complications."
* Reasoning: The simple summary data for each intervention group and effect estimates and confidence intervals are presented.
* Response: [Yes]
P21. "P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency."
* Quote: "Statistical heterogeneity was assessed using the I2 statistics. If the I2 value was less than 50%, then a fixed effects meta-analysis was applied; if the I2 value was 50% or more, then the random effects meta-analysis was used."
* Reasoning: The results of each meta-analysis are presented, but the confidence intervals and measures of consistency are not provided.
* Response: [No]
P22. "P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
* Quote: "Not applicable in the text."
* Reasoning: The results of any assessment of risk of bias that may affect the cumulative evidence are not provided.
* Response: [No]
P23. "P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression)."
* Quote: "Not applicable in the text."
* Reasoning: The results of additional analyses are not provided.
* Response: [No]
P24. "P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)."
* Quote: "Conclusions: Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH."
* Reasoning: The main findings are summarized, and the strength of evidence for each main outcome is considered.
* Response: [Yes]
P25. "P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)."
* Quote: "Conclusions: Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH."
* Reasoning: The limitations at study and outcome level and at review-level are discussed.
* Response: [Yes]
P26. "P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research."
* Quote: "Conclusions: Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH."
* Reasoning: The general interpretation of the results is provided in the context of other evidence, and the implications for future research are discussed.
* Response: [Yes]
P27. "P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
* Quote: "The review was supported by the National Natural Science Foundation of China, Program for New Century Excellent Talents in University, Scientific Research Foundation for the Returned Overseas Chinese Scholars, and Fundamental Research Funds for the Central Universities."
* Reasoning: The sources of funding for the systematic review and other support are described.
* Response: [Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
LLM response
13 quote(s) from
publication full text (mean similarity 53.4%)
20 quote(s)
from the LLM prompt briefing (mean similarity 46.3%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
A1: "The review was conducted by two independent reviewers who screened the titles and abstracts of the identified studies and extracted the data from the included studies." [Yes]
A2: "The review included studies published in English between 1990 and 2013." [No]
A3: "The review included studies that reported on the incidence, clinical presentation, diagnosis, and management of postoperative intussusception in children." [Yes]
A4: "The review included studies that reported on the incidence, clinical presentation, diagnosis, and management of postoperative intussusception in children." [Yes]
A5: "The review included studies that reported on the incidence, clinical presentation, diagnosis, and management of postoperative intussusception in children." [Yes]
A6: "The review included studies that reported on the incidence, clinical presentation, diagnosis, and management of postoperative intussusception in children." [Yes]
A7: "The review included studies that reported on the incidence, clinical presentation, diagnosis, and management of postoperative intussusception in children." [Yes]
A8: "The review included studies that reported on the incidence, clinical presentation, diagnosis, and management of postoperative intussusception in children." [Yes]
A9: "The review did not combine data in a quantitative synthesis." [NA]
A10: "The review did not assess publication bias." [NA]
A11: "The review did not use a validated tool to assess the quality of the included studies." [NA]
P1: "An explicit statement of the research question or objectives was provided." [Yes]
P2: "The inclusion and exclusion criteria were specified." [Yes]
P3: "The search strategy was described, including the databases, search terms, and language restrictions." [Yes]
P4: "The study selection process was described, including the number of studies screened, assessed for eligibility, and included in the review." [Yes]
P5: "The characteristics of the included studies were reported, including the study design, population, intervention, and outcomes." [Yes]
P6: "The risk of bias in the included studies was assessed using a validated tool." [NA]
P7: "The results of the individual studies were reported in a systematic and structured manner." [Yes]
P8: "The results of the individual studies were combined in a meta-analysis if appropriate." [NA]
P9: "The results of the meta-analysis were reported, including the effect size, confidence interval, and heterogeneity." [NA]
P10: "The risk of bias in the meta-analysis was assessed using a validated tool." [NA]
P11: "The results of the meta-analysis were interpreted in the context of the overall evidence." [Yes]
P12: "The conclusions were supported by the data and were free from bias." [Yes]
P13: "The limitations of the review were discussed." [Yes]
P14: "The funding sources were reported." [NA]
P15: "The potential conflicts of interest were reported." [NA]
P16: "The review was registered in a PROSPERO registry or equivalent." [NA]
P17: "The review adhered to the PRISMA statement or equivalent." [Yes]
P18: "The review adhered to the AMSTAR checklist or equivalent." [Yes]
P19: "The review adhered to the MOOSE checklist or equivalent." [NA]
P20: "The review adhered to the QUOROM statement or equivalent." [NA]
P21: "The review adhered to the STROBE statement or equivalent." [NA]
P22: "The review adhered to the CONSORT statement or equivalent." [NA]
P23: "The review adhered to the PRISMA for Abstracts checklist or equivalent." [NA]
P24: "The review adhered to the EQUATOR Network guidelines or equivalent." [NA]
P25: "The review adhered to the Cochrane Handbook for Systematic Reviews of Interventions or equivalent." [NA]
P26: "The review adhered to the GRADE guidelines or equivalent." [NA]
P27: "The review adhered to the CARE guidelines or equivalent." [NA]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Mixtral-8x7B)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Mixtral-8x7B)
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
LLM response
8 quote(s) from
publication full text (mean similarity 96.4%)
26 quote(s)
from the LLM prompt briefing (mean similarity 83.3%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
AMSTAR:
A1. Was an 'a priori' design provided? The research question and inclusion criteria should be established before the conduct of the review.
* "The aim of our study was to investigate whether children who underwent SIPES suffer from greater postoperative pain than those who underwent SL."
* The research question and inclusion criteria are clearly stated in the introduction.
* Response: [Yes]
A2. Was there duplicate study selection and data extraction? There should be at least two independent data extractors and a consensus procedure for disagreements should be in place.
* "Patients who underwent SIPES via Olympus TriPort™ Access system between 2010 and 2011 were prospectively compared with SL controls (similar age, sex and type of operation)."
* The study mentions a prospective comparison of SIPES and SL controls, but it does not explicitly state that there were two independent data extractors or a consensus procedure for disagreements.
* Response: [No]
A3. Was a comprehensive literature search performed? At least two electronic sources should be searched. The report must include years and databases used (e.g., Central, EMBASE, and MEDLINE). Key words and/or MESH terms must be stated and where feasible the search strategy should be provided. All searches should be supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found.
* "Scientific data-bases (PubMed, Medline, OVID, ERIC, and Cochrine Collaboration) were searched using the keywords 'single port surgery' and 'child'."
* The study mentions searching five scientific databases and using specific keywords, but it does not provide information on the years covered or the databases used.
* Response: [No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc.
* "Studies reporting adult series or paediatric case reports were excluded."
* The study mentions excluding adult series and paediatric case reports, but it does not explicitly state that they searched for reports regardless of their publication type.
* Response: [No]
A5. Was a list of studies (included and excluded) provided? A list of included and excluded studies should be provided.
* "The two orchidopexy procedures were a first- and second-stage Fowler-Stephens procedure on the same (left) testicle of a patient who had previously undergone liver transplant. In this child, SIPES was opted in order to minimise access to an abdomen full of adhesions and with a large liver."
* The study does not provide a list of included and excluded studies.
* Response: [No]
A6. Were the characteristics of the included studies provided? In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes. The ranges of characteristics in all the studies analyzed e.g., age, race, sex, relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.
* "The 10 SIPES procedures were compared with 10 similar SL procedures, performed in children possibly of similar age, weight and gender to the SIPES group, who underwent a similar type of operation during the same study period."
* The study mentions comparing SIPES and SL procedures, but it does not provide a table or aggregated form of the characteristics of the included studies.
* Response: [No]
A7. Was the scientific quality of the included studies assessed and documented? 'A priori' methods of assessment should be provided.
* "All patients received local anesthesia via transmural injection before trocar insertion. Postoperative pain treatment consisted of intravenous and/or oral administration of one or a combination of paracetamol, ibuprofen, and/or diclofenac."
* The study does not mention assessing and documenting the scientific quality of the included studies.
* Response: [No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
* "The study does not provide any conclusions or recommendations based on the scientific quality of the included studies.
* Response: [NA]
A9. Were the methods used to combine the findings of studies appropriate?
* "The study does not perform a meta-analysis, so it is not applicable to assess the methods used to combine the findings of studies.
* Response: [NA]
A10. Was the likelihood of publication bias assessed?
* "The study does not perform a meta-analysis, so it is not applicable to assess the likelihood of publication bias.
* Response: [NA]
A11. Was the conflict of interest included?
* "The study does not mention any conflicts of interest.
* Response: [Yes]
PRISMA:
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
* "MINERVA PEDIATR 2035,67:457-463 Is single incision pediatric endoscopic surgery more painful than standard laparoscopy in children? Personal experience and review of the literature"
* The title identifies the report as a systematic review.
* Response: [Yes]
P2. Abstract / Structured summary: Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.
* "The abstract provides a structured summary including background, objectives, data sources, study eligibility criteria, participants, and interventions, but it does not mention study appraisal and synthesis methods, limitations, or conclusions and implications of key findings."
* Response: [No]
P3. Introduction / Rationale: Describe the rationale for the review in the context of what is already known.
* "The introduction describes the rationale for the review in the context of what is already known."
* Response: [Yes]
P4. Introduction / Objectives: Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
* "The introduction provides an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)."
* Response: [Yes]
P5. Methods / Protocol and registration: Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
* "The methods do not mention if a review protocol exists or provide registration information including registration number."
* Response: [No]
P6. Methods / Eligibility criteria: Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
* "The methods do not specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale."
* Response: [No]
P7. Methods / Information sources: Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
* "The methods describe the information sources (e.g., databases with dates of coverage) in the search and date last searched."
* Response: [Yes]
P8. Methods / Search: Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
* "The methods do not present the full electronic search strategy for at least one database, including any limits used, such that it could be repeated."
* Response: [No]
P9. Methods / Study selection: State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
* "The methods do not state the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)."
* Response: [No]
P10. Methods / Data collection process: Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
* "The methods do not describe the method of data extraction from reports or any processes for obtaining and confirming data from investigators."
* Response: [No]
P11. Methods / Data items: List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
* "The methods do not list and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made."
* Response: [No]
P12. Methods / Risk of bias in individual studies: Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
* "The methods do not describe methods used for assessing risk of bias of individual studies or how this information is to be used in any data synthesis."
* Response: [No]
P13. Methods / Summary measures: State the principal summary measures (e.g., risk ratio, difference in means).
* "The methods do not state the principal summary measures (e.g., risk ratio, difference in means)."
* Response: [No]
P14. Methods / Synthesis of results: Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
* "The study does not perform a meta-analysis, so it is not applicable to describe the methods of handling data and combining results of studies."
* Response: [NA]
P15. Methods / Risk of bias across studies: Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "The study does not perform a meta-analysis, so it is not applicable to specify any assessment of risk of bias that may affect the cumulative evidence."
* Response: [NA]
P16. Methods / Additional analyses: Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
* "The study does not perform additional analyses, so it is not applicable to describe methods of additional analyses."
* Response: [NA]
P17. Results / Study selection: Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
* "The results do not give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram."
* Response: [No]
P18. Results / Study characteristics: For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
* "The results do not present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations for each study."
* Response: [No]
P19. Results / Risk of bias within studies: Present data on risk of bias of each study and, if available, any outcome level assessment (see item P12).
* "The results do not present data on risk of bias of each study or any outcome level assessment."
* Response: [No]
P20. Results / Results of individual studies: For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
* "The results do not present simple summary data for each intervention group or effect estimates and confidence intervals for each study."
* Response: [No]
P21. Results / Synthesis of results: Present results of each meta-analysis done, including confidence intervals and measures of consistency (e.g., I2).
* "The study does not perform a meta-analysis, so it is not applicable to present results of each meta-analysis done."
* Response: [NA]
P22. Results / Risk of bias across studies: Present results of any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
* "The study does not perform a meta-analysis, so it is not applicable to present results of any assessment of risk of bias that may affect the cumulative evidence."
* Response: [NA]
P23. Results / Additional analysis: Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression).
* "The study does not perform additional analyses, so it is not applicable to give results of additional analyses."
* Response: [NA]
P24. Discussion / Summary of evidence: Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).
* "The discussion does not summarize the main findings including the strength of evidence for each main outcome or consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)."
* Response: [No]
P25. Discussion / Limitations: Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).
* "The discussion does not discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)."
* Response: [No]
P26. Discussion / Conclusions: Provide a general interpretation of the results in the context of other evidence, and implications for future research.
* "The discussion provides a general interpretation of the results in the context of other evidence and implications for future research."
* Response: [Yes]
P27. Funding: Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.
* "The study does not mention any sources of funding for the systematic review or other support (e.g., supply of data); role of funders for the systematic review."
* Response: [No]